Objective To evaluate the value of DWI parameter ADC and intravoxel incoherent motion(IVIM) derived parameters in grading extrahepatic cholangiocarcinoma(EHCC).Methods Thirty-eight consecutive patients with surgically resected and pathologically confirmed EHCC while the minimum diameter of the lesions large than 5 mm were included in this retrospective study.Patients underwent upper abdomen 3.0 T MR(including conventional MRI and DWI scansequences).Importing original images into the IVIM post-processing software,each patient were set three times of ROIs and each time interval was one week.ROI were selected in the same position of the maximum solid part of lesions area,the average value of ADC,blood flow(BF),pure molecular diffusion(D),perfusion-based molecular diffusion(D*),perfusion fraction(f) were measured.According to WHO digestive tumor specimens grading method,divided these cases into Ⅰ,Ⅱ,Ⅲ grade group.Evaluate the association by Spearman correlation analysis and compare the diagnostic potential of parameters ADC、BF、D、D*、f by using ROC analysis.Results Thirty eight cases of EHCC include:grade Ⅰ 11 cases,grade Ⅱ] 15 cases and grade Ⅲ 12 cases.ADC values of these three groups were (1.33 ± 0.22) × 10-3,(1.21 ± 0.18) × 10-3,(0.98 ± 0.10) × 10-3mm2/s,respectively.BF values were (2.40± 1.01) × 10-3,(2.37± 1.19) × 10-3,(1.64±0.46) × 10-3mm2/s.D values were (1.30±0.13) × 10-3,(1.15 ±0.13) × 10-3,(0.87±0.11) × 10-3mm2/s.D* values were (5.67±0.70) × 10-3,(6.58 ± 1.82) × 10-3,(5.43±2.82) × 10-3mm2/s.And f values were (38.03± 10.02)％,(31.36±8.34)％,(22.04±7.93)％.ADC,D,and f values were significantly correlated with histologic grade(r=0.624,0.809,0.580;P＜0.01,respectively).BF and D* were both not significantly correlated(r=0.271,0.017;P=0.099,0.920,respectively).Areas under the ROC curve for the five parameters ADC,BF,D,D*,f were 0.785,0.603,0.889,0.421,0.781,respectively.Conclusions With the reduction of histological differentiation degree,ADC,D,f values decreased.Correlation between f value and pathological differentiation degree is poor whie the correlation of D and ADC were excellent,and the correlation of D is the highest.

As the important content of excellent quality nursing service, the performance appraisal of nursing staff was closely interrelated to their income distribution, professional title promotion and excellence choosing. Performance appraisal was the requisite part of nursing resource management. This study gave an overview about conception and development of nursing staff′s performance appraisal and summarize key performance indicator,balanced score card,SMART principle and 360 degrees performance appraisal, which was mainly used in domestic hospital. It suggested nursing manager should have complementary advantages of them and utilize foreign mature methods to explore and improve our countries performance appraisal of nursing staff and formulate the system which was in keeping with China′s national conditions.

Objective To explore aspirin resistance (AR) and its relevant influencing factors in patients on maintenance hemodialysis (MHD).Methods Patients on MHD who visited Beijing Chaoyang Hospital from June 1 to 30,2011 were enrolled in this study.A total of 150 age and gender matched individuals with normal renal function were taken as control group.Anthropometric data,biochemistry parameters,ultrasonography and thromboelastograph (TEG) were inspected in the both groups.AR was defined as inhibiting rate of acetylsalicylic acid drugs [MA (AA)] ＞ 50％ by TEG.Results Among the total 391 patients on MHD,hypercoagulation was found in 18 patients (4.6％),nomal coagulation in 288 patients (73.7％) and hypocoagulation in 85 patients (21.7％).Pearson's correlation analysis revealed that the reaction time (R) and the thrombus maxithrombelastic degree (MA) values were not correlated with the levels of hemoglobin and platelet in MHD patients.A total of 306 patients with hypercoagulation and normal coagulation were chosen as the MHD group.Compared with the control group,higher high sensitivity C reactive protein (hsCRP),homocysteine (Hcy) and R value were observed in the MHD group (P ＜ 0.05),while MA was significantly lower in the MHD group.Statistically higher incidence of AR was shown in the MHD group (48.0％ vs 20.0％,P =0.00).Patients in the MHD group were divided into the AR group and the aspirin sensitive (AS) group by the result of TEG.Compared with the AS group,patients in the AR group were found to be older with a higher female/male ratio,longer dialysis sustained time,higher ratio of diabetes history,higher hsCRP,Hcy and fasting blood glucose (FBG) and MA.They also manifested a higher incidence of cardiovascular and cerebrovascular diseases,peripheral vascular disease and arteriovenous fistulas with thrombosis with more spots of carotid artery and higher intima thickness of carotid artery (IMT) (all P values ＜0.05).Lower R value was shown in the AR group.Binary logistic regressive analysis revealed that the ratio of diabetes history,age and dialysis sustained time.Hcy and hsCRP were the independent risk factors for AR in patients on MHD.A total of 289 patients on MHD with atherosclerosis were followed up for the mean time of 18.0 months with no hemorrhage found in the process.Cox proportional hazards regression modeling demonstrated that AR was associated with the major adverse longterm outcome of the vascular events [HR =0.40,95 ％ CI 0.29-0.72,P =0.00].Conclusions The ratio of platetet activation in patients on MHD is significantly lower than in those with normal renal function.Small dose of aspirin could be prescribed for the patients on MHD with atherosclerosis to prevent vascular events.The incidence of AR is 48.0％ in the MHD group and the independent risk factors for AR in MHD patients are the ratio of diabetes history,age,dialysis sustained time,Hcy and hsCRP.AR is associated with the major adverse long-term outcome of acute vascular events.

Objective To investigate aspirin resistance (AR) and its related factors in patients with stage 3-4 chronic kidney disease(CKD).Methods The clinical data of 108 patients with stage 3-4CKD from nephrology department in Beijing Chaoyang Hospital were collected (CKD group) ; and 110 age and sex-matched subjects with normal renal function served as control group.Anthropometric parameters,blood biochemistry index,ultrasonography and thromboelastograph (TEG) were examined in both groups; and inhibition ratio of arachidonic acid ＞ 50％ on TEG was defined as AR.Results The incidence of cardio-cerebral vascular disease,the incidence of peripheral vascular disease,ratio of female,the intimamedia thickness (IMT) of carotid artery,the levels of high-sensitive C-reactive protein (hsCRP),homocysteine(Hcy),evaluated glomerular filtration rate(eGFR) and maximal thrombelastodegree (MA) on TEG in CKD group were significantly higher than those in control group (all P ＜ 0.05),while R value was significantly lower in CKD group.Pearson's correlation analysis revealed that the levels of MA,hsCRP,Hcy,IMT were positively correlated and R value was negatively correlated with eGFR in CKD group.The incidence of AR in CKD group (32.4％) was significantly higher than in control group (20.0％).According to TEG,the patients were divided into AR group (n =35) and aspirin sensitive (AS) group (n =73).The incidence of cardio-cerebral vascular disease,the incidence of peripheral vascular disease,ratio of female,IMT,ratio of diabetes,the levels of hsCRP,Hcy,fasting plasma glucose (FBG),eGFR and MA in AR group were significantly higher than those in AS group (all P ＜ 0.05),while R value was significantly lower in AR group.Binary logistic regressive analysis revealed that the ratio of diabete,FBG,eGFR,hsCRP were independent risk factors for AR in patients with stage 3-4 CKD.Conclusions CKD stage 3-4 is associated with increased ratio of platelet activation and atherosclerosis,and this condition is aggravated while eGFR declining.Incidence of AR is 32.4％ in this group of CKD patients,the independent risk factors of AR in CKD patients are the ratio of diabetes,FBG,eGFR and hsCRP.

Objective: To explore clinical significance by detecting the expression of HLA-DR antigen in peripheral blood T lymphocyte subsets of patients with cirrhosis after splenectomy. Methods: Twenty eight patients with cirrhosis received splenectomy were enrolled in the study, meanwhile, thirty eight patients with cirrhosis without splenectomy and twenty-two health donors were followed-up as the controls. The expressions of HLA-DR antigen in peripheral blood T lymphocyte subsets were detected by flow cytometry. Results: The levels of CD3+, CD4+ and CD8+ were(41.59?6.79)% ,(22.64?6.87)% and(19.16?7.28)% respectively in peripheral blood of patients with splenectomy, which were significantly lower than that of the controls. The ratio of CD4+/CD8+ was higher than that of the health control. The expressions of HLA-DR on CD3+, CD4+ and CD8+ were (25.42?5.51)% , (22.36?4.90)% and (28.53?8.35)% respectively in peripheral blood of patients with splenectomy. The expression of HLA-DR on CD4+ and CD8+ in patients with splenectomy was significantly higher than that of patients without splenectomy. Conclusion: There is cellular immune deficiency in patients with splenectomy. The expression of CD3+, CD4+ and CD8+ decrease significantly, and the levels of activated antigen HLA-DR on T cell subsets are low.

Objective To observe the changes of urinary microalbumin(UMA),and explore the relation between early impairment of renal function and level of UMA in patients with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods OSAHS patients(n=67)and healthy control subjects(n=82).Then body parameter,serum creatinine(SCr),blood urea nitrogen(BUN),glomerular filtration rate(GFR)and UMA were determined in both groups.Furthermore,linear correlation was performed between UMA and body parameter,SCr,BUN,GFR and sleep-breathing parameters of patients with OSAHS,respectively.Results UMA level was higher in OSAHS patients than that in control subjects(P＜0.01).UMA level in OSAHS patients was correlated positively with body mass index(BMI),apnea hypopnea index(AHI),percentage of sleep time below 90% oxygen saturation (SaO2＜90%)and percentage of sleep time the total duration of apnea/hypopnea,respectively,and those were correlated negatively with the lowest SaO2 and the average lowest SaO2 respectively,but those had no correlativity with age,stature,waistline,neckline,SCr,BUN and GFR(P＞0.05).Conclusions UMA level increases in patients with OSAHS.The detection of microalbumin in urine is helpful in early diagnosis in OSAHS renal damage patients.

Objective To analyze the effects of the mumps virus on testicular function and evaluate the value of blood testosterone in acute orchitis condition and prognosis by observing the testosterone levels of peripheral blood in the mumps orchitis patients.Methods Thirty patients with acute mumps orchitis (mumps orchitis group)and 28 patients with mumps only without any major complications (mumps group)were enrolled in the study.At the same time,we selected 20 healthy males in our hospital as healthy controls.All cases were treated by ribavirin (10mg/kg). The testosterone was tested by chemiluminescence method,in 0,7,14 days respectively.The variance analysis and LSD -t test were used to compare differences of blood testosterone in each group,and Pearson method was used to analyze the correlation of blood testosterone and testicular swelling day times,blood amylase,level of neutrophils,IL -6 and CRP.Results The testosterone of acute orchitis [(1.51 ±0.26)ng/mL]was lower than mumps group and healthy controls.The difference was significant(F =99.36,P <0.01).The level of blood testosterone was significantly increased in the treatment for 14 days (t =13.03,P <0.01),and there was no significant difference compared with healthy controls (t =1.23,P =1.23).Pearson correlation analysis found that blood testosterone levels were negatively correlated with the days of testicular swelling,the levels of IL -6 and CRP(r =0.678,P <0.01 and r =0.528,P =0.000;r =0.442,P =0.000).Conclusion This study showed that MuV infection inhibited testosterone synthesis in Leydig cells.In other words,the level of blood testosterone is related to the severity of the orchitis,which can be widely used in clinical.

BACKGROUND: Osteoporosis is one of the complications of spinal cord injury, but its mechanism is unclear, different scholars have different points about whether all bones above and below the level of trauma are affected after spinal cord injury (SCI).OBJECTIVE: To observe the ultrastructure of bone tissue of secondary osteoporosis after spinal cord injury and the change of serum biochemical indexes, to analyze the suffered condition and injured degree of the bones above and below the level of the trauma.DESIGN: Randomized controlled experimentSETTING: Laboratory of Animals, and Department of Laboratory Medicine of the Second Clinical Hospital of Jilin University; Transmission Electron Microscope Center, Norman Bethune Division of Medical Sciences of Jilin UniversityMATERIALS: This experiment was conducted at the Laboratory of Animals, Second Clinical Hospital of Jilin University from May 2002 to May 2003. Totally 110 male Wistar rats, aged 4 to 5 month-old, with the body mass of (300 -320)g were involved.METHODS: Ten rats were randomly chosen from 110 male Wistar rats and were set as 0 week blank control group, the ther rats were randomly divided into experimental group and control group, there were 10 rats in week 1, 2, 3, 7 and 11 control group and experimental group separately.1 mL/L of pentobarbital natrium was intraperitoneal injected to perform anesthesia, in the control group, lamina with dura intact of rats were removed only, without spinal cord injury at the level of tenth thoracic vertebrae. In the experimental group, lamina of rats was also removed, the spinal cord injury model of the rats were made by the method of Allen's.4 mL venous blood was collected from the animals at the end of postoperative week 0, week 1, week 2, week 3, week 7 and week 11, then the animals were put to death, perform blood centrifuging .We observe the change of serum concentration of calcium, phosphorus and alkaline phophatase (ALP) with 7170A HITACHI auto-biochemistry analyzer. Right side humerus, tibia in week 0 blank control group, week 7 experimental group and week 11 experimental group were chosen, then 25 mL/L ethylene dinitrilotetraacetic acid was used for decalcium for 1 month for preparingthe sections. We observe the change of ultrastructure of osteocytes at the sites of tibial plateau and the surgical neck of the humerus after stained by uranyl acetate and lead citrate under transmission electron microscope.biochemistry detection: the level of phosphorus at week 2 of the experiment was significantly lower in the control group than experiment group [(1.54±0.21),(2.76±0.16)mmol/L, (P ＜ 0.01)]; the level of calcium at week 3 in the experiment group was significantly higher than in the control group [(2.52±0.06),(2.35±0.12)mmol/L, (P ＜ 0.01)];the level of alkaline phophatase at week 7 in the experiment group was significantly higher than in the control group [(155.86±20.42), (129.25±7.30)Nμ/mg,operative week 7, the tibia sample showed that the osteocyte separated from the osseous lacuna, the nucleus showed anomaly, fluffed materials appeared. Mitochondrion swelled, rough endoplasmic hollowed; At week 11, osteocyte separated from the osseous lacuna. At postoperative 7 week,the humerus sample showed that osteocyte separated from osseous lacuna,some nucleus pycnosis and rough endoplasmic hollowed; At postoperative week 11, the above changes still were seen, but the degree of cellular swelling and hollowing were lighten.CONCLUSION: At the early stage of spinal cord injury, the activity of osteoclast is increased and the activity of osteoblast is decreased, which leads to the increase of bone absorption, the bone formation is largely weakened. The bones above and below the level of trauma are both affected after spinal cord injury, but different extents of osteoporosis can be seen in different bones .The change of ultrastructure of osteocytes is remarkable when osteoporosis has happened.

Aim To observe the improvement of visual-auditory cognitive functions in the human entering high altitude by taking in tea polyphenols.Methods Thirty eight males living at 3 700 m high altitudes for 90 days constantly were randomly divided into two groups: ①group Ⅰ(placebo,40 mg/day); ②group Ⅱ(TP,300 mg/day).Cognitive functions were measured by integrated visual and auditory continuous performance test and the difference between groups was evaluated by the comparisons of post-treatment to pre-treatment.Results Compared with pre-treatment,PruA was significantly higher after taking in TP(P

In November 1981,an ancient female cadaver of Qidan nationality in wulanchatu League of InnerMongolia was excavated.This cadaver was estimated approximately 25 year of age.She has been buriedfor about 900 years.The cadaver was a mummified corpse,and preserved in a comparatively intact state. The hair was intact and dark brown in colour.All viseral organs were dreg-like and dark brown incolour.The individual organ could not be identified from its exernal appearance.Only lungs werepreserved,adhering to the back of the thoracic cavity and looked like dry leaves.The peritonem wasdry and translucent and contained a few blood vessels.The muscles were also dry and dark brown or brownishgray in colour.The alveoli and the parenchma of the lung as well as bacterial spores were identified.The histologicalstructure of tissues from the heart region looked like the cross section of cardiac fiber.Collagenous fiberswere seen.Other tissues were mostly autolyzed.The cadaver were group B.According to results of toxic analysis,larger amount of arsenic was demonstratedin tissues from the stomach region.So it was deduced that the lady might die of an arsenical poisoning.Factors involving in the well preservation of this case are discussed.