Objective To investigate the clinical significance of prostate specific antigen density (PSAD)value in the differential diagnosis from malignant and benign prostate disease .Methods 56 patients who enrolled in this hospital during April 2008 to No-vember 2012 were reviewed ,all of them were suspected as prostate carcinoma with free total PSA value at 4-10 ng/mL .Prostate volume were determined via transrectal ultrasound ,while serum PSA was determined by chemiluminescence method ,and all patients were finally pathologically diagnosed via tissue biopsy or prostatectomy .21 cases were proved to be prostate carcinoma (prostate carcinoma group) ,and the other 35 cases were proved to be benign prostate hyperplasia(BPH) .And the statistical significances of tPSA ,prostate volume and PSAD values were compared between the two groups .Results Compared with BPH group ,serum level of tPSA was insignificant ,while the values of prostate volume and PSAD were significantly lower in the BPH group than in prostate carciboma group .Considering the mean prostate volume(39 .27 mL) as the reference point ,40 mL was set as the cut-off value of prostate volume .Therefore ,there were 80 .95% prostate carcinoma group patients whose prostate volume were less than 40 mL , and 68 .57% benign prostate hyperplasia group patients whose prostate volume were larger than 40 mL .Considering the PSAD val-ue(0 .147) as the reference point ,0 .15 was set as the cut-off value of PSAD .Therefore ,the sensitivity ,specificity ,positive predic-tive value and negative predictive value among patients with prostate volume less than 40 mL ,the datas were respectively as 80 .95% ,72 .73% ,85% and 61 .54% .While ,among patients with prostate volume larger than 40 mL ,were respectively as 75% , 66 .67% ,27 .27% and 94 .11% .Conclusion PSAD was of certain value in the differential diagnosis of prostate carcinoma in PSA gray zone cases .If PSAD=0 .15 was consider as the cut-off point ,the sensitivity and specificity of differential diagnosis for prostate carcinoma decreased as the prostate volume increase .However ,the influencing factors are still to be elucidated .

Objective To evaluate the efficacy of acting κ opioid receptor for prevention of high altitude pulmonary edema (HAPE) in rats.Methods Forty male Sprague-Dawley rats,aged 8 weeks,weighing 250-300 g,were randomly divided into 5 groups (n =8 each) using a random number table:control group (group C),hypobaric hypoxia group (group H),normal saline + hypobaric hypoxia group (group NH),U50488H (a selective kappa-opioid receptor agonist) + hypobaric hypoxia group (group UH),and nor-binaltorphimine (norBNI,a selective kappa-opioid receptor antagonist) + U50488H + hypobaric hypoxia group (group NUH).The rats were put into the hyperbaric chamber and exposed to hypobaric hypoxia (atmospheric pressure 355 mmHg,partial pressure of oxygen 74 mmHg) for 2 days to induce HAPE.At 3 days before HAPE,normal saline 0.5 ml,U50488H 1.25 mg/kg,and nor-BNI 2.0 mg/kg were injected intraperitoneally once a day in NH,UH,and NUH groups,respectively,and in addition U50488H 1.25 mg/kg was injected intraperitoneally 10 min later in NUH group.After 2 h exposure to hypobaric hypoxia,mean pulmonary artery pressure (mPAP) was detected,and arterial blood samples were collected for determination of serum malondialdehyde (MDA) and erythropoietin (EPO) levels.The rats were then sacrificed and lungs were removed for microscopic examination and for determination of the levels of nitric oxide (NO),inducible nitric oxide synthase (iNOS),MDA,superoxide dismutase (SOD),endothelin-1 (ET-1),thromboxane B2 (TXB2),and 6-keto-prostaglandin F1α (6-keto-PGF1α) in lung tissues.Lung water content and TXB2/6-keto-PGF1α ratio was calculated.Results Compared with group C,mPAP,lung water content,ET-1,MDA,TXB2 and 6-keto-PGF1α levels,TXB2/6-ketoPGF1α ratio,and serum MDA and EPO levels were significantly increased,and iNOS,NO and SOD levels were decreased in the other four groups (P ＜ 0.05).Compared with group H,mPAP,lung water content,ET-1,MDA,TXB2 and 6-keto-PGF1α levels,TXB2/6-ketoPGF1α ratio and serum MDA and EPO levels were significantly decreased,and iNOS,NO and SOD levels were increased in UH group (P ＜ 0.05),and no significant changes were found in the indexes mentioned above in NH and NUH groups (P ＞ 0.05).The pathological changes of lung tissues were significantly attenuated in group UH as compared with H group.Conclusion Acting κ opioid receptor can produce prevention for HAPE in rats,and inhibition of lipid peroxidation and correction of the imbalance between vasoconstrictive factors and vasodilative factors may be involved in the mechanism.

Objective To investigate the epidemiological and clinical characteristics of an outbreak of tsutsugamushi disease in Chuzhou region, Anhui Province, and to clarify the new changes of epidemic focus of tsutsugamushi disease in China. Methods Field epidemiological investigation and analysis of clinical features were done. The detections of specific antibodies against Rickettsia tsutsugamushi were conducted to diagnose tsutsugamushi disease using colloidal gold immunochromatography assay combined with Well-Felix reaction. The geomorphic and climatic characteristics of the new epidemic focus were investigated. Results The outbreak occurred from October to November, 2007. The epidemic focus located on mountainous brushland regions, and the air temperature fluctuated from 20-4 ℃. Nineteen cases of tsutsugamushi disease in the new-found epidemic focus were finally diagnosed, 9 cases out of them were hospitalized, another 9 had recovered when diagnosed by serological tests; the remaining one had classical manifestations of tsutsugamushi disease but did not receive the serological test for certain cause. The main clinical symptoms were chilly in 14 cases, fever in 19 cases, headache in 15 cases; among the 9 hospitalized patients, the symptoms were lymphadenectasis in 8 inpatients, skin rash in 7 inpatients, splenomegaly in 4 inpatients and skin eschar and ulcer in 7 inpatients and Weil-Felix reaction by OXκantigen positive in 4 cases; the specific antibodies against Rickettsia tsutsugarnushi of 18 tested cases were all positive. No severe complications occurred in all patients. Before the first case was identified, all other cases were not diagnosed in time and did not receive correct antibiotic treatment. Nine hospitalized patients recovered rapidly with the treatment of doxycycline. Conclusions The outbreak of tsutsugamushi disease in Anhui Province in 2007 is type of emerged in autumn and transitional epidemic focus. There is epidemic focus of tsutsugamushi disease in northern region of Anhui Province. Doxycycline is rapid and effective for the treatment of tsutsugamushi disease.

Objective To explore the application value of pulmonary artery monitoring program for intracranial and cervical artery angiography with dual-energy CT.Methods Sixty patients performed intracranial and cervical artery angiography with dual-energy CT were divided into two groups according to the random number table.Group A (optimization group,30 patients):the monitoring points were located in the main pulmonary artery,with threshold 150 HU,trigger delay time 8-9 s,pitch 0.9,and the iohexol (350 mg I/ml) 60-65 ml.Group B (conventional group,30 patients):the monitoring points were located in aortic arch,with threshold 100 HU,trigger delay time 5 s,and the iohexol (350 mg I/ml)60-70 ml.Patients with the body weight less than 75 kg were injected with the flow rate of 4.0 ml/s,and those weight greater than 75 kg or with body mass index (BMI) greater than 27 kg/m2 were 4.5 ml/s,following 40 ml saline solution with the same flow rate respectively.All images were transferred to Siemens Syngo workstation for further processing and analysis.The attenuation values were measured on axial images in the common carotid artery,internal and external carotid artery,vertebral and basilar artery,the horizontal segment of the middle cerebral artery,the subclavian vein of injection side,the proximal,middle and distal segment of jugular vein,the straight sinus and the superior sagittal sinus.Two experienced observers blinded independently evaluated the image quality of CTA,the impact of contrast material residues artifacts of subclavian vein of injected side and the affect of venous return factors on arterial image display.Images of volume rendering technique(VR),the maximum intensity projection (MIP),and curved planar reformation (CPR) were reconstructed using dual energy bone removal and Inspace and 3D software.The mean intraluminal attenuation of contrast material (HU),the volume of contrast material and the mean image quality scores were compared with t test between the two groups.Chi-square test was used to compare of image contrast agents residual artifacts,the absence segments of the root of the neck artery,and the degree of the jugular vein return in two groups.Results The mean CT values were 372-414 HU for each segment of artery showing no significant differences between two groups (P ＞ 0.05).In group A,the CT values of the jugular vein in proximal,middle,distal segment of the two sides were (95 ± 36),(95 ± 36),(131 ±58),(133 ± 57),(174 ± 68),and (180 ± 66) HU respectively.In group B,CT values were (135 ± 58),(137 ±59),(170 ±58),(181 ±58),(218 ±62),and (224 ±68) HU.The CT value of jugular venous in group A was significantly lower than that in group B (t =-3.30--2.54,P ＜ 0.05).Case numbers of contrast agent residual artifacts of injection side subclavian vein and the absence segments of root of the neck artery at the beginning in group A (5,11) were less than that in group B (12,24) (x2 =4.02,5.65,P ＜0.05).The degree of the jugular vein return in group A were lesser severely than that in group B (x2 =6.79,6.37,P ＜0.05).Below the level of carotid artery bifurcation:slight 5 patients,severe 1 patient in group A vs.slight 15 patients,severe 9 patients in group B.Above the level of carotid artery bifurcation:slight 9 patients,severe 6 patients in group A vs.slight 12 patients,severe 17 patients in group B.Image quality scores of group A (3.84 ± 0.40) was higher than that of group B (3.64 ± 0.63) (t =4.26,P ＜0.05).Conclusions Pulmonary Artery Monitoring combines with 60-65 ml contrast material optimization scheme for intracranial and cervical artery angiography with dual energy CT can significantly reduce the degree of jugular venous return and contrast material residues artifacts of subclavian vein of injected side.This technique is helpful to improve the work efficiency and image quality.

Objective To investigate ACEI ( benazepril ) and tranilast exert renoprotective properties in diabetic nephropathy( DN) through the inhibition of thioredoxin( Trx) . Methods Forty male SD rats were randomly divided into normal control group,model control group,tranilast group and benazepril group (n=10 each).Normal control group was fed with normal diet. Other groups were fed with high-glucose high-fat diet to make DN models. Rats in model control, tranilast, and benazepril groups were fed with normal diet,400 mg??kg-1??d-1 tranilast plus normal diet,and 10 mg??kg-1??d-1 benazepril plus normal diet,respectively,via oral gavage for 12 weeks.The 24-hour proteinuria,blood glucose(BG),blood urea nitrogen (BUN),serum creatinine ( Scr) and renal pathology changes were detected. Expression of Trx was measured by Western-blot. Results The 24 h urine protein, BG, BUN, Scr, kidney/body weight, and glomerular sclerosis index were significantly decreased in tranilast group and benazepril group,as compaired with model control group ( P<0.05) ,but there was no statistical difference between the two drug groups (P>0.05).Both tranilast and benazepril can reduce renal pathological changes,and can increase the expression of Trx of DN rats, but benazepril had a more significant effect on increasing Trx expression. Conclusion Both tranilast and benazepril have renoprotective function in DN, and benazepril is more effective than tranilast in delaying the progression of diabetic nephropathy by increasing Trx expression and decreasomg oxidative stress.

Objective To investigate the effect of nerve growth factor (NGF) on osteogenesis induced by bone morphogenetic protein-9 (BMP-9) in mouse embryonic fibroblasts (MEFs).Methods MEFs were respectively transfected with adenovirus-mediated NGF (NGF group), BMP-9 (BMP-9 group) and NGF + BMP-9 (combined group) and green fluorescence protein (GFP) (control group).Cytochemical staining was used to test the activity of alkaline phosphatase (ALP) 3 d and 5 d after treatment.Level of osteopontin (OPN) mRNA was detected by RT-PCR 9 d after treatment.Level of OPN protein was assayed by Western blot and immunocytochemistry 9 d after treatment.Mineralization was detected by Alizarin red staining 14 d after treatment.Results ALP activity in MEFs was elevated in BMP-9 group rather than in NGF group, but a significant increase in ALP activity was noted in combined group.In control group, BMP-9 group, NGF group and combined group, level of OPN mRNA was 0.92 ± 0.03, 1.28 ± 0.04, 0.94 ± 0.03 and 1.62 ± 0.04 respectively (F =214.60, P ＜ 0.01);level of OPN protein was 0.60 ± 0.05, 0.84 ± 0.03, 0.53 ± 0.05 and 1.27 ± 0.05 respectively (F =162.5, P ＜ 0.01).In comparison, OPN mRNA and protein were significantly up-regulated in combined group than in BMP-9 group (t =10.569 and 11.778,P ＜ 0.05).In control group, BMP-9 group, NGF group and combined group, relative density of OPN protein was 3.63 ±0.17, 6.27 ±0.30, 3.86 ±0.18 and 10.16 ±0.18respectively (F =602.6, P ＜ 0.01), with a significant higher level in combined group than in BMP-9 group (t =22.280, P ＜ 0.05).Level of mineralization was significantly higher in combined group than in BMP-9 or NGF group.Conclusion NGF can potentiate the osteogenesis induced by BMP-9 in MEFs.

Objective To evaluate the imaging quality and radiation doses of dual-source computed tomography (DSCT) coronary angiography at a low tube voltage in patients with medium and low heart rate.Methods Eighty-five patients[heart rate (HR) ＜ 91 beats per minute (bpm); body mass index (BMI) 17. 51-30. 00 kg/m2]suspected of coronary artery disease received retrospectively ECG-gating coronary angiography with dual-source CT scanner (Somatom Definition, Siemens) at a tube voltage of 100 kVp. For all patients, no beta-blocker was used before CT scan. According to the HR, the patients were divided into three groups: Group A, HR ≤ 59 bpm, n = 27; Group B, HR 60-69 bpm, n = 29; Group C,HR ≥70 bpm, n = 29. All images were transferred to a workstation for postprocessing. The best R-R interval reconstruction images of all groups were evaluated. The value of pitch, CT volume dosage index (CTDIvol), dose length product (DLP)and effective dose (ED)were recorded. The pitch, the score of imaging quality of coronary artery segments and the radiation dose were compared with one-way ANOVA. The influence of HR on image quality and radiation doses of coronary artery was analyzed. Results The value of pitch in Group A, Group B and Group C was 0. 241 ± 0. 025, 0. 286 ± 0. 034 and 0. 335 ± 0. 036,respectively. The mean score of imaging quality of coronary artery segments in Group A, Group B and Group C was 4. 78 ± 0. 26, 4. 66 ± 0. 56 and 4. 70 ± 0. 46, respectively. The value of CTDIvol in Group A,Group B and Group C was (18.06 ±5. 16), (19. 62 ±7. 15) and (17. 50 ±7. 13) mGy, respectively. The value of ED in group A, Group B and Group C was (4.23 ± 1.76), (4.59 ± 1.75) and (4.12 ±1.39) mSv, respectively. There was statistical difference in value of pitch among the three groups (F =60. 00, P= 0. 00). There were no statistical difference in score of imaging quality, CTDIvol and value of ED among the three groups (F = 0. 53, P = 0. 59; F = 0. 83, P = 0. 44 ; F = 0. 86, P = 0. 43). Conclusion Medium and low HR have little influences on image quality of dual-source CT coronary angiography at a low tube voltage. When the auto ECG-gating is selected, there is little influence on radiation dosage as well.

Spinal tuberculosis is one of the common causes of severe kyphosis. The formation of spinal tuberculosis kyphosis is multi-factors, including age at the time of infection, the cumulative number of segments, the height of vertebral body loss before treatment, and "spine danger signs" . Although the use of anti-tuberculosis drugs has achieved good results, for patients with spinal tuberculosis cured by drug treatment, the kyphosis will continue to progress and gradually develop into a severe kyphosis. Then there are a series of problems such as appearance, psychology, rib-pelvic impingement, cardiopulmonary dysfunction, and nerve and spinal cord compression. The X-ray signs of the height of the vertebral body loss and "spine danger signs" before treatment can help predict the severity of future deformities. Therefore, a comprehensive understanding of the formation of kyphosis of spinal tuberculosis and individualized selection of surgical methods according to the specific conditions of the disease as soon as possible can effectively prevent the formation of kyphosis and reduce the incidence of neurological damage and delayed paralysis.

Objective:To compare the clinical effect of combined anterior and posterior approach and posterior median approach to treat O'Driscoll type III b fracture of ulnar coronoid process.Methods:A retrospective case control study was made on 67 patients with O'Driscoll type III b fracture of ulnar coronoid process treated in Honghui Hospital, Xi'an Jiaotong University from January 2015 to January 2019, including 35 males and 32 females, aged from 21 to 61 years [(38.0±9.4)years]. Among them, 31 patients were treated with combined anterior and posterior approach for reduction and internal fixation (combined approach group), and 36 patients with median posterior elbow approach group for reduction and internal fixation (posterior elbow approach group). The operation time, amount of intraoperative blood loss and fracture healing time were compared between groups. The visual analogue score (VAS), elbow joint range of motion and Mayo elbow performance score (MEPS) were assessed for pain and function evaluation at postoperative 1, 3, 6 months and at the last follow-up. The occurrence of complications were observed as well.Results:All patients were followed up for 12 to 28 months [(20.1±4.2)months]. There was no significant difference in operation time and VAS between the two groups ( P>0.05). The intraoperative blood loss [(133.6±20.3)ml] and fracture healing time [(12.3±1.7)months] in combined approach group were less or shorter than those in posterior elbow approach group [(144.4±22.1)ml, (13.2±2.0)months] ( P<0.05). The range of flexion and extension of elbow joint in combined approach group [(88.7±10.8)°, (111.1±13.9)°, (121.3±14.1)°, (127.1±13.3)°] was higher than that in posterior elbow approach group [(74.5±11.8)°, (97.6±12.6)°, (111.3±13.0)°, (115.2±12.7)°] at postoperative 1, 3, 6 months and at the last follow-up ( P<0.05). The MEPS in combined approach group [(31.7±8.6)points, (55.6±9.3)points, (84.6±10.5)points, (85.0±10.3)points] was higher than that in posterior elbow approach group [(27.2±8.2)points, (50.7±8.7)points, (77.4±11.2)points, (80.1±9.4)points] at postoperative 1, 3, 6 months and last follow-up ( P<0.05). The incidence of complications in combined approach group [10%(3/31)] was lower than that in posterior elbow approach group [31%(11/36)]( P<0.05). Conclusion:Compared with the simple posterior elbow median approach, the combined anterior and posterior elbow approach for treatment of O'Driscoll type IIIb fracture of ulnar coronoid process has lower intraoperative blood loss, faster fracture healing, lower incidence of complications and better elbow function.

Objective:To compare the efficacy of metaphyseal expansion and non-expansion when using proximal femoral nail antirotation（PFNA）in the treatment of severe osteoporotic intertrochanteric fracture in the elderly.Methods:A retrospective case-control study was conducted to analyze the clinical data of 66 elderly patients with severe osteoporotic intertrochanteric fracture admitted to Honghui Hospital, Xi'an Jiaotong University from January 2019 to January 2020, including 49 males and 17 females. The age ranged from 75 to 89 years［（80.9±3.3）years］. The AO types of fractures were 31-A1 in 23 patients, 31-A2 in 22 and 31-A3 in 21. A total of 34 patients were stabilized by the PFNA technique with metaphyseal expansion（metaphyseal expansion group）and 32 patients received PFNA fixation without metaphyseal expansion（metaphyseal non-expansion group）. The total blood loss, hidden blood loss, intraoperative blood loss, dominant blood loss, postoperative drainage, transfusion volume, transfusion rate, operation time, hospital stay and fracture healing time were compared between the two groups. The hip functional recovery was assessed by Harris hip score at 1, 3, 6 months postoperatively and at the last follow-up. The incidence of complications was observed.Results:All patients were followed up for 12-17 months［（13.5±1.1）months］. The total blood loss, hidden blood loss, intraoperative blood loss, dominant blood loss, postoperative drainage in metaphyseal expansion group were（976.3±210.1）ml,（712.4±224.4）ml,（139.4±21.0）ml,（263.8±36.3）ml,（124.4±29.5）ml respectively, significantly higher than those in metaphyseal non-expansion group［（799.0±119.5）ml,（603.0±136.4）ml,（94.1±18.8）ml,（195.9±35.4）ml,（101.9±27.5）ml］（ P<0.05）. The transfusion volume［2（0, 2）U］and transfusion rate［53%（18/34）］in metaphyseal expansion group ware increased compared to metaphyseal non-expansion group［0（0, 1.5）U, 25%（8/32）］（ P<0.05）. There were no significant differences in operation time, hospital stay, fracture healing time or hip Harris score at 1, 3, 6 months after surgery and the last follow-up between the two groups（ P>0.05）. No wedge-shaped distraction deformity, fracture nonunion, femoral head necrosis, wound infection, pulmonary embolism or fat embolism occurred in both groups. There was no significant difference in the incidence of iatrogenic lateral wall fracture, lower limb venous thrombosis or postoperative medical complications between the two groups（ P>0.05）. Conclusion:For elderly patients with severe osteoporotic intertrochanteric fracture, both PFNA with metaphyseal expansion and non-expansion can achieve satisfactory results, while the metaphyseal non-expansion is superior in perioperative blood loss and transfusion rate.