Constructivism teaching theory emphasizes the central role of student in learning and this theoretical framework holds that learning always builds upon the active exploring and discovering new knowledge.Department of orthopedics in the first affiliated hospital of Chongqing Medical University introduced and implemented constructivism teaching in teachers' research and teaching activity as well as in students' learning.This mobilized students' learning enthusiasm and improved clinical teaching quality.

Objective To explore the feasibility of DSCT dual-energy technique in pulmonary mass lesions.Methods A total of 100 patients with pulmonary masses underwent conventional plain CT scan and dual-energy enhanced CT scan.The virtual non-contrast (VNC) images were obtained at post-processing workstation.The mean CT value,enhancement value,signal to noise ratio (SNR),image quality and radiation dose of pulmonary masses were compared between the two scan techniques using F or t test and the detectability of lesions was compared using Wilcoxon test. Results There was no statistically significant difference among VNC ( A ) ( 32.89 ± 12.58 ) HU,VNC (S) ( 30.86 ± 9.60) HU and conventional plain images (35.89 ± 9.99 ) HU in mean CT value of mass ( F =2.08,P ＞ 0.05 ).There was statistically significant difference among VNC ( A ) ( 3.29 ± 1.45 ),VNC (S) ( 3.93 ± 1.49 ) and conventional plain image (4.61 ± 1.50) in SNR ( F =6.01,P ＜ 0.05 ),which of conventional plain scan was higher than that of VNC.The enhancement value of mass in conventional enhanced scan(60.74 ± 13.9)HU and distribution of iodine from VNC (A) ( 58.26 ± 31.99 ) HU was no statistically significant difference ( t =0.48,P ＞ 0.05 ),but there was a significant difference between conventional enhanced scan (56.51 ± 17.94 ) HU and distribution of iodine from VNC (S) (52.65 ± 16.78 ) HU (t =4.45,P ＜ 0.05 ).There was no statistically significant difference among conventional plain scan ( 4.69 ± 0.06 ) and VN C ( A ) ( 4.60 ± 0.09 ),VNC (S)(4.61 ±0.11 ) in image quality at mediastinal window ( F =3.014,P ＞ 0.05 ).The appearance,size,internal features of mass (such as necrosis,calcification and cavity) were showed the same in conventional plain scan,VNC (A) and VNC (S).Of 41 patients with hilar mass,18 patients were found to have lobular and segmental perfusion decrease or defect. Perfusion defect area was found in 59 patients with peripheral lung mass. The radiation dose of dual-energy enhanced scan was lower than that of conventional scan.Conclusion The virtual non-contrast,distribution of iodine and pulmonary virtual perfusion images can be obtained by DSCT dual-energy technique in one scan,which has a potential clinical value in the thorax.

PurposeTo analyze the urinary stone chemical composition using dual source CT (DSCT) dual energy imaging.Materials and MethodsNinety-seven stone samples with known chemical composition were placed in fresh swine kidneys and examined with DSCT dual energy scan, including 55 calcium oxalate stones, 13 hydroxyapatite stones, 9 uric acid stones, 4 cystine stones, 2 struvite stones and 14 mixed stones. The mean attenuation values and dual energy index (DEI) were measured at 80 kV and 140 kV. The stone composition was analyzed to determine the sensitivity, specificity and accuracy.ResultsDual energy analysis showed 59 calcium oxalate stones, 11 hydroxyapatite stones, 9 uric acid stones, 4 cystine stones and 14 mixed stones. 2 hydroxyapatite stones were erroneously marked as calcium oxalate stones and 2 struvite stones as calcium oxalate stones. The accuracy was 95.88% (93/97). The difference CT value at 80 kV and 140 kV and DEI value were statistically significant (P<0.05). The sensitivity for detecting calcium oxalate stones, hydroxyapatite stones, uric acid stones and cysteine stones were 100.00%, 84.60%, 100.00% and 100.00%, respectively; with specificity of 85.70%, 100.00%, 100.00% and 100.00%, respectively; and the accuracy were 95.18%, 97.59%, 100.00% and 100.00%, respectively.ConclusionDSCT dual energy imaging accurately analyzes the chemical composition of urinary stone in vitro, which provides important clinical value in analyzing the urinary stonesin vivo.

Purpose To investigate the second generation dual source CT low tube voltage (100 kV) combined with sonogram-affirmed iterative reconstruction (SAFIRE) in assessing coronary artery stents. Materials and Methods One hundred and fifty-six patients underwent CT coronary angiography after implanted coronary artery stents. Among all the patients, 86 cases were performed with 100 kV combined with SAFIRE, and 70 cases with 120 kV combined with filtered back projection reconstruction (FBP). Mean CT values, image noise, SNR, SAIR, image quality scores, stents detecting and radiation dose of aortic root, inner-stent, and the coronary artery proximal to the stent were compared. Results The mean CT value of aortic root, inner-stent, and the coronary artery proximal to the stent of 100 kV group was higher than that of 120 kV group (t=2.75, 11.77 and 3.19, P<0.05), while image noise and SAIR of 100 kV group were lower than those of 120 kV group (t=-2.53 and -9.51, P<0.05). SNR of aortic root, inner-stent, and the coronary artery proximal to the stent was not statistically different between the two groups (t= -1.34, -0.95 and 1.67, P>0.05). There was no statistic difference of image quality score between the two groups (t= -0.203, P>0.05). Totally there were 243 stents detected, including 67 of right coronary artery, 123 of left anterior descending, 36 of left circumflex, and 17 of other branches. Stent length ranged 3.8 to 98.7 mm and averaged (27.5±16.4) mm. The CTDIvol, DLP and ED of 100 kV group were lower than those of 120 kV group (t= -11.03, -9.41 and -9.41, P<0.05). The effective dosage reduced about 51.5% in 100 kV group when compared with that of 120 kV group. Conclusion The second generation dual source CT low tube voltage (100 kV) combined with SAFIRE in assessing coronary artery stent could meet the diagnostic requirement and reduce the radiation dosage, without increasing image noise and beam hardening artifacts.

Objective To study the epidemiology,pathologies and clinical manifestations of renal diseases in elderly patients of different genders in China northwest region.Methods Retrospective analysis was used to evaluate the clinical and pathological informations of patients above 60 years old who underwent renal biopsy and had the integrated data in the past 20 years.Results (1)Among the 559 patients,there were 347 men accounting for 62.1％,and there were 212 women accounting for 37.9％ ； the average age was (66.7±5.3)years,the median course of disease was 5.0months when receiving renal biopsy,and 50％ cases was (1.3 ～ 12.0)months.(2) Primary glomerulopathy accounted for 69.59％(389/559),secondary glomerulopathy,tubulointerstitial disease and the others accounted for 25.4％ (142/559),3.8％ (21/559) and 1.3％ (7/559),respectively.(3)According to clinical manifestation,nephrotic syndrome was the most common disease(accounting for 60.7％),and then chronic glomerulonephritis accounted for 31.6％.In pathology,membranous nephropathy was the most frequently category accounting for 34.5％,then mesangial proliferative glomerulonephritis accounted for 32.4％.(4) Among secondary glomerulopathy,the frequent diseases were primary polyangitis,diabetic nephropathy,amyloidosis of kidney and lupus nephritis,accounting for 24.7％,19.7 ％,13.4 ％ and 10.6 ％,respectively,and the number of women was more than men in lupus nephritis(P＜0.05).(5) The common diseases of primary glomerulopathy that would result in renal insufficiency were nephrotic syndrome and chronic glomerulonephritis,accounting for 76.5 ％ (26/34)and 76.2 ％ (48/63),respectively,and the common pathological type was both mesangial proliferative glomerulonephritis.The common diseases of secondary glomerulopathy that would result in renal insufficiency were primary small vessel vasculitis and diabetic nephropathy,accounting for 46.3％(19/41)and 34.4％(11/32),respectively.Conclusions (1)the number of men was more than women in this group,and was opposite in lupus nephritis.(2) The most common disease was primary glomerulopathy,as for clinical manifestation,nephrotic syndrome and chronic glomerulonephritis were most common； the most common pathological type were membranous nephropathy and mesangial proliferative glomerulonephritis.(3) The common disease resulting in secondary kidney damage were primary small-vessel vasculitis and diabetic nephropathy.(4)The pathological type of disease resulting in renal insufficiency was mesangial proliferative glomerulonephritis,the common diseases resulting in acute renal insufficiency were nephrotic syndrome,primary small vessel vasculitis,and those resulting in chronic renal insufficiency were chronic glomerulonephritis and diabetic nephropathy.

Acute Disease ; Adolescent ; Adult ; Animals ; Child ; Child, Preschool ; Female ; Foodborne Diseases ; diagnosis ; etiology ; therapy ; Humans ; Male ; Meat ; poisoning ; Middle Aged ; Pesticides ; poisoning ; Swine ; Treatment Outcome

Objective:To investigate the relationship between the distance from the upper and lower resection margin and the gastric cancer patients with R0 resection and no distant metastasis.Methods:Retrospective analysis of 281 patients with gastric cancer in our hospital,the relationship between the age,sex,tumor size,tumor size,vascular invasion,lymph node metastasis,TNM stage,type of gastric cancer,tumor location and operation mode was analyzed.To compare the survival time of patients with different upper and lower margins.Results:The increase of the distance from upper resection margin was significantly related to the tumor size＞5 cm,TNM stage,type of gastric cancer,tumor location,and the difference was statistically significant(P＜0.05);The distance of lower resection margin was significantly correlated with tumor size＞5cm,vascular invasion,lymph node metastasis and TNM stage,type of gastric cancer,and the difference was statistically significant (P＜0.05);Themedian survival timein patientsof upper resection marginr□3cm with 48 months of the 5-year follow-up period was significantly higher than that in patients of the resection margin＞3cmwith 46 months (P＜0.001).Themedian survival timein patientsof lower resection margin□3cm with 45 months of the 5-year follow-up period was significantly higher than that in patients of the resection margin＞3cm with 44 months (P＜0.001).Conclusion:Gastric cancer postoperative upper and lower resection margin was significantly related with tumor size,TNM staging factors,and the median survival time of upper and lower resection margin＞5 cm was significantly lower than that of the resection margin3 cm.

Objective To investigate risk factors of the prognosis of patients with severe fever with thrombocytopenia syndrome (SFTS).Methods From May 2012 to July 2014,17 cases of severe fever with thrombocytopenia syndrome in Renmin Hospital of Wuhan University were treated.Clinical data including history of epidemiology,clinical manifestations,complications,physical examination and laboratory test results on admission and the third day after admission were retrospectively analyzed and compared with the death group and recovery group by application of Spearman correlation analysis.Results Elderly male patients with neuropsychiatric symptoms,or abnormal liver function,or abnormal blood clotting function had higher risk of the poor prognosis.In SFTS patients,AST,ALT was significantly increased,AST 539 U/L (229.73,545.4) U/L (r =0.597,P =0.015) was a risk factor affecting prognosis.Elevated blood ammonia indicated serious liver dysfunction and neurological dysfunction which were manifested as irritability,delirium,and trembling limbs.In SFTS patients,platelets were significantly decreased accompanied with mouth ulcers / bleeding gums,gastrointestinal bleeding.PLT 24.88 × 10 9/L-1 (12.75,35.00) ×10 9/L-1 (r=0.557,P=0.005) or APTT 86.06 s (66.88,114.18) (r=0.798,P=0.001) or D-dimmer 9.79 mg / L (4.09,16.51) mg/L (r =0.597,P =0.015) are risk factors affecting poor prognosis.Conclusions On the third days after admission,AST,WBC,PLT,APTT,Ddimmer are risk factors for prognosis of patients with severe fever with thrombocytopenia syndrome infected by a novel bunyavirus.

Objective To discuss the correlation between nutritional megaloblastic anemia and homocysteine,in order that e-valuate the application of homocysteine in some aspects that detection and treatment of megaloblatic anemia.Methods The study was divided into three groups,included case group (MA group,n=192,including megaloblatic anemia of vitamin B12 deficiency,n=60;megaloblatic anemia of folic acid deficiency,n=69;megaloblatic anemia of folic acid and vitamin B12 defi-ciency,n=63),matched group (heathy persons,n=200)and treated group (persons who recovered from megaloblatic ane-mia,n=192).Results The difference on homolevel in plasma between case group and matched group had statistical sidnifi-cance (t=3.56,3.21,2.78,P <0.01).The difference on homocysteine level in plasma between treated group and matched group had no statistical sidnificance (t=1.23,0.98,0.77,P >0.05).The Hcy levels of folic acid deficiency vitamin B12 de-ficiency,vitamin B12 deficiency and folic acid and vitamin B12 deficiency had no statistical sidnificance (t=1.42,P >0.05). Conclusion The homocysteine level of patients who had nutritional megaloblatic anemia higher than heathy persons.High level of homocysteine had correction between the nutritional megaloblatic anemia.The lack of some nutrition facters (eg:fo-lic acid,vitamin B12)can lead to high homocysteine disease.Detecting the change of homocysteine level in plasma can guide the treatment of nutritional megaloblatic anemia.

Objective To investigate the value of low-dose coronary artery imaging with flash dual-energy CT.Methods In total of 240 patients suspected with coronary heart disease were performed dual-energy CCTA(DE-CCTA)and were divided into four groups according to the A tube electric current and the methods of reconstruction,including group A(conventional group:180 mAs+FBP)and low-dose groups(including group B,C,D:1 50 mAs,120 mAs,90 mAs +SAFIRE,respectively).The mean of CT value, image noise,SNR,CNR,image quality and radiation dosage were compared among the four groups.Among the patients,52 cases with coronary artery stenosis which were diagnosised by DE-CCTA were also confirmed by CAG,and the consistency of these two methods in the diagnosis of coronary artery stenosis were compared.Results The scores of all image quality were more than 3 points and were statistically significant among the four groups(P <0.05).The mean of CT value is not statistically significant (P >0.05), while the image noise,SNR,CNR and the radiation dosage were statistically significant (P <0.05)among the four groups.The ED of group D was lower 55.62% than group A.DE-CCTA and CAG in the diagnosis of coronary artery stenosis had satisfactory consistency (Kappa=0.84,P<0.05).Conclusion Low-dose coronary artery DE-CCTA not only have none affect of image quality and diagnostic accuracy, but also can significantly reduce the radiation dosage.