Continuous quality improvement is the essence and core of modern hospital quality management.Our hospital attaches great importance to quality management and constantly improves the system of management and takes charge of implementation of implement.Continuous quality improvement is based on actual condition in order to stimulate the staff′s enthusiasm, initiative and form the hospital culture of participating in quality management jointly.It can improve the overall quality of the hospital management in the process of the implementation of continuous quality improvement by finding and analyzing problems, actively implementing, and strengthening staffs′ consciousness of quality gradually.

Objective To explore the value of the percentage of necrotic surface area in predicting collapse of osteonecrosis. Methods 15 hips of avascular necrosis of the femoral head(ANFH) in 9 patients underwent MRI scan. On the MRI films, the percentage of necrotic surface area were calculated. While on the specimens of the 15 hips, the percentage of necrotic surface area were also measured. In 16 hips of 8 patients of ANFH with serials MRI at mean 18.9 months intervals (range, 6-41 months), the percentage of necrotic surface area were calculated and compared. In 38 hips of 27 patients without collapse, the percentage of necrotic surface area and the index of necrosis were calculated on MRI films. Follow-up was terminated when crescentic sign illustrated on X-ray film or CT demonstrated articular facet collapse. Those hips without collapse were followed up more than 24 months. The value of the percentag of necrotic surface area and the index of necrosis in predicting collapse of osteonecrosis was observed. Results The percentage of necrotic surface area were 63.23%?10.16% on specimens and 63.60%?7.78% on MRI films respectively. There were no significant differences between them. The percentage of necrotic surface area on specimens were coincidence with those on MRI. In the 16 hips with serials MRI; the percentage of necrotic surface area were 52.37%?19.91% on the first MRI films, 51.70%?21.29% on the second. There were no significant differences between them. This result revealed that the percentage of necrotic surface area did not vary with the extension of course of disease. In the 38 cases of early necrosis, 28(73.7%) hips collapsed and 10(26.3%) hips did not. The relative risk of the percentage of necrotic surface area was 1.043, and the relative risk of the index of necrosis was 1.020. No significant difference was found in ARCO staging for patients with or without femoral head collapse. It demonstrated that whether ischemic necrotic femoral head collapse or not had no relation with its ARCO stage. Conclusion The percentage of necrotic surface area can be used as more accurate predictor for future collapse.

[Objective]To explore the causes and treatments of recurrent dislocation after total hip replacement.[Method]From July 1999 to January 2007,there were 47 cases of dislocation after total hip replacement.Thirteen cases were recurrent.CT and serial X-rays were taken to observe the position of prosthesis.The strength of their hip abductor was also tested.Stability test was used to value the stability of hip.Closed reduction,modular adjustments and revision were adopted according to patients,willingness,prosthesis and stability.[Result]All of the 13 patients had malposition.Eleven cases were tested with instability.Five cases were successfully treated by closed reduction.Despite dislocation reoccurred 1～2 times every year in 3 patients treated by closed reduction,patients felt satisfactory.In the 4 cases with modular revision procedure,2 cases changed the neck length,1 case used elevated liner and larger neck length,1 cases treated by using larger offset and adjusting abnormal liner.Another one treated by revision.[Conclusion]Malposition is the major causes of recurrent dislocation.The prosthesis test whowed instability.The treatments of recurrent dislocation after THA should use different ways according to the causes of dislocation,stability of prosthesis and the willingness of patients.

Objective To evaluate the safety and effect of laryngeal mask airway (LMA) general anesthesia in neonatal laparoscopic pyloromyotomy. Methods The clinical data of 100 neonates who had underwent laparoscopic pyloromyotomy were retrospectively analyzed. The neonates were divided into LMA group (50 cases) and tracheal intubation group (50 cases) according to the anesthesia method. The heart rate and mean arterial pressure (MAP) were recorded at the time points of preanesthesia (T0), tracheal intubation (T1), 10 min after tracheal intubation (T2) and extubation (T3), and the extubation time, and consumption of sevoflurane and postoperative complications were also recorded. Results All the 2 groups had smooth intubation and LMA, and the operation was completed successfully under laparoscope. There was no conversion to laparotomy. In LMA group, there were no statistical difference in heart rate and MAP at all the time points (P>0.05). The heart rate and MAP at T1 and T3 in tracheal intubation group were significantly higher than those at T0, and there were statistical differences (P<0.05). The heart rate and MAP at T1 and T3 were significantly lower than those in tracheal intubation group, heart rate:(131.1 ± 11.0) times/min vs. (146.9 ± 13.7) times/min and (131.9 ± 9.8) times/min vs. (147.3 ± 14.6) times/min; MAP: (44.2 ± 5.5) mmHg (1 mmHg = 0.133 kPa) vs. (47.9 ± 8.4) mmHg and (45.1 ± 7.3) mmHg vs. (49.1 ± 9.4) mmHg, and there were statistical differences (P<0.01 or<0.05). The extubation time, consumption of sevoflurane and incidences of postoperative complications in LMA group were significantly lower than those in tracheal intubation group:(6.1 ± 2.2) min vs. (12.5 ± 3.6) min, (2.9 ± 1.1) ml vs. (5.1 ± 1.9) ml and 4％ (2/50) vs. 48％ (24/50), and there were statistical differences (P<0.01). Conclusions LMA anesthesia in neonatal laparoscopic surgery is activated to maintain the steadiness of hemodynamics, which has less stress, anesthetic drugs consumption and respiratory complications compared with tracheal intubation .

Objective:To analyze the causes of early dislocation after total hip replacement and explore its preventions and treatments. Methods:From July 1997 to October 2002, there were 12 cases of dislocation after total hip replacement. The strength of their hip abductor was tested and the X-ray films were measured. If closed reduction failed, capsular repairing was used. Results:There were 3 cases of malposition, 5 cases of abnormal soft-tissue tension, 3 cases of malposition and abnormal soft-tissue tension and 1 case of over motion. Close reduction was succeeded in 5 cases, 7 cases failed to close reduction, and were treated successfully by repairing the hip capsule and readjusted the prostheses when necessary. Conclusion:Abnormal soft-tissue tension has become the main causes of dislocation after total hip replacement. Those cases in which closed reduction has failed can be treated by repairing the hip capsule.

Objective To explore the value of 1H-MRS on the evaluation of Alzheimer's disease (AD) with neural stem cells (NSCs) transplantation in an APP-PS1 double transgenic (tg) AD mouse model.Methods NSCs from C57BL/6 mice were cultured and amplified.APP-PS1 tg mice (n =30) aged 12 months were used as the study group,and mild-type mice (n =15) were used as the control group.Animals in the study group were randomized into two subgroups,the AD mice in one subgroup received NSCs transplantation (NSCs group) and in another subgroup received phosphate buffer saline (PBS,PBS group)in bilateral hippocampal CA1.Animals in the control group were not treated.Using a 7.0 T high-fieldstrength MR imager,1H-MRS was performed before and 6 weeks after transplantation to measure the area under the peak of n-acetyl aspartate (NAA),glutamate (Glu),myo-inositol ( mI),choline (Cho) and creatine (Cr) in the hippocampal area,NAA/Cr,Glu/Cr,mI/Cr and Cho/Cr ratio were calculated and compared with histopathological results (including Nissl's staining and electron microscope examination).Comparisons among NSCs,PBS and control groups were conducted by one-way ANOVA.Results NSCs from C57BL/6 mice were cultured successfully. Before transplantation,the mean NAA/Cr,Glu/Cr and mI/Cr in NSCs,PBS and control groups were 0.89 ± 0.05,0.88 ± 0.04 and 1.15 ± 0.05,0.40 ± 0.03,0.39 ± 0.03 and 0.45 ± 0.05,0.67 ± 0.05,0.67 ± 0.05 and 0.52 ± 0.04,respectively,and differences were statistically significant (F =148.918,7.529,59.468,P ＜ 0.01 ). There were no significant differences in NAA/Cr,mI/Cr and Glu/Cr ratios between NSCs and PBS groups before transplantation (t =0.147,0.096,0.207,P ＞ 0.05 ),but the differences were significant compared with the control group (t =0.255,0.467,0.171 and t =0.269,0.527,0.151,P ＜0.05).Six weeks after transplantation,the mean NAA/Cr,Glu/Cr and mI/Cr in three groups were 1.13 ±0.07,0.86 ±0.05 and 1.14 ±0.05,0.45 ± 0.04,0.38 ± 0.02 and 0.44 ± 0.03,0.58 ± 0.04,0.67 ± 0.04 and 0.53 ± 0.04,respectively,and differences were statistically significant ( F =112.092,23.076,44.367,P ＜ 0.01 ).NAA/Cr and Glu/Cr ratios were increased and mI/Cr was decreased in NSCs group,and the difference was significant compared with PBS group at the same time point ( t =0.271,0.071,0.089,P ＜ 0.05 ).There were no significant differences in NAA/Cr and Glu/Cr ( t =0.013,0.012,P ＞ 0.05 ),but there was a significant difference in mI/Cr between NSCs and control groups ( t =0.046,P ＜ 0.05).There were no significant differences in Cho before and after transplantation among the three groups (P ＞ 0.05 ). Nissl's staining showed that the number of neurons in the hippocampal area increased more significantly in tg mice receiving NSCs than that without receiving NSCs.Electron microscopy showed that most hippocampal NSCs in NSCs group were morphologically normal with abundant organelles,while hippocampal NSCs in PBS group were swollen with sparse synapses.Conclusion 1H-MRS is able to display intracranial metabolite changes before and after NSCs in APP-PS1 double transgenic AD mice and has an applicable value in evaluating the therapeutic effect of NSCs on AD.

Objective To explore changes of metabolites in APP/ PS1 double transgenie mice of Alzbeimer disease (AD) by 1H-MR spectroscopy (1H-MRS) and the application value of in early diagnosis of AD.Methods 1H-MRS was performed in 35 APP/PS1 transgenie mice of AD ( study group) and 20 wild type mice ( control group) at age of 3, 6 and 9 months using a 7.0 T MR system.Sub-peak areas of N-acetyl aspartate (NAA), myo-inositol (mI) and creatine (Cr) in the cerebral cortex and hippocampus were measured, and the NAA/Cr and mI/Cr ratios were calculated.The changes in pathology between the two groups were compared.Using the lower limit of 95% confidence interval (CI) of the ml/Cr ratio and the upper limit of 95% CI of the NAA/Cr ratio of AD mice as the threshold, their influences on sensitivity,specificity and accuracy of various age groups of AD animals were compared.Comparison of the 1H-MRS indexes between study mice and wild type mice at each time point were conducted by a two-sample t test.Results The mean mI/Cr ratios of AD mice were 0.68± 0.03, 0.72± 0.04, and 0.77 ± 0.04 respectively at 3, 6 and 9 months of age; while they were 0.63 ± 0.04, 0.64 ± 0.03, and 0.64 ± 0.04 respoetively in control group, the difference was significant ( t = 2.814, 5.146, 14.437, P < 0.01 ).Compared with the control group, the mI/Cr ratio of the 3-month-old AD mice of the study group was significantly increased,and histological examination showed proliferation and activation of neuroglial cells in the cerebral cortex and hippoeampus.The mean NAA/Cr ratio were 1.17 ±0.08, 1.04 ±0.05, and 0.90 ±0.05 respectively at 3,6 and 9 months of age in study group, while they were 1.18 ±0.07, 1.16 ±0.07, and 1.18 ±0.08respectively in control group.There were no significant difference ( t = 0.752, P > 0.05 ) between the study group and control group at 3 months of age, and the NAA/Cr ratio decreased significantly only at 6 and 9 months of age ( t = - 8.514, - 5.646, P < 0.01 ).The immunohistochemical exam demonstrated the appearance of Aβ plaque.According to threshold of mI/Cr, the sensitivity of AD mice of 3, 6 and 9 months of age was 80% (28/35), 84% ( 26/31 ) and 85% ( 23/27 ), and the specificity was 85% ( 17/20 ),94% (17/18) and 100% ( 16/16), and the accuracy was 82% (45/55), 88% (43/49) and 91% (39/43),respectively.For NAA/Cr, the sensitivity of AD mice of 6 and 9 months of age was 84% (26/31) and 89% (24/27), and the specificity was 89% (16/18) and 100% (16/16), and the accuracy was 86% (42/49) and 93% (40/43), respectively.Conclusions NAA and mI are the most sensitive and specific markers for early assessment of AD, and change of mI is earlier than that of NAA.Quantitative analysis of mI may provide important clues for early diagnosis of AD.

Objective To explore the protective effect of atorvastatin on irradiated endothelium and the thrombomodulin(TM)expression.Methods Cultured human coronary artery endothelial cells(HCAEC)and human umbilical vein endothelial cells(HUVEC)were treated by atorvastatin at the final concentration of 10 μmol/ml for 10 min,and then irradiated with 2 and 25 Gy.Cell cycles status and TM expression were quantitatively measured by flow cytometry 24 hours after irradiation.Protein C activation in endothelial cells was also assessod.Results After administration with atorvastatin for 24 h,the TM expression increased by 77%,59% and 61% in normal control group,2 Gy group and 25 Gy group,respectively(t=27.395,26.420,58.065;P=0.000).The protein C levels decreased by 23% and 34% compared with the normal group post-irradiation to 2 and 25 Gy,but increased by 79% and 76% compared with the irradiated control group after administration with atorvastatin.The rates of cell apoptosis decreased by 6% and 16% in 2 Gy and 25 Gy groups,respectively after administration with atorvastatin for 24 h(t=4.178,17.863;P=0.000).Conclusions Atorva statin can protect endothelia cell from irradiation-induced apeptosis by increasing TM expression and protein C activation.

Objective To study the capability of high field MRI in demonstrating the post-mortem fetal brains at different gestational age(GA).Methods One hundred and eight post-mortem fetal brains of 14-40 weeks GA were evaluated by 3.0 T MRI. Eleven brains of 14 to 27 weeks GA with good 3.0 T MRI images were chosen and scanned by 7.0 T MRI. The developing sulci, layered structures of fetal cerebral cortex and basal nuclei were evaluated on MRI of different Tesla(3.0 T and 7.0 T)and their results analyzed. Results On T_1 WI of 3.0 T MRI, the layered structures of fetal cerebral cortex were present at 14 weeks GA, the sulci were more accurately identified after 16 weeks GA. The basal nuclei were clearly distinguishable after 20 weeks GA. and these structures were better visualized as the GA increased. On T_2WI of 7.0 T MRI, the sulei, layered structures of fetal cerebral cortex and basal nuclei were shown more clearly at the same GA when compared to 3.0 T, especially the sulci at the early developmental stages. Conclusions T_1 WI of 3.0 T MRI could show the developing structures of post-mortem fetal brain well, but the T_2 WI of 7.0 T MRI were comparatively better.

Objective To study the developmental process of the region of basal nuclei of postmortem fetuses by 3.0 T and 7.0 T MRI.Methods One hundred and thirty-one postmortem fetuses of 14 to 40 weeks of gestational age(GA)were scanned by 3.0 T MR,of which 11 fetuses of 14-27 weeks of GA were chosen and scanned by 7.0 T MR. The time when the structures in the region of basal nuclei could be detected and the changes of MR signal intensity were analyzed for MRI of different Tesla.Results On 3.0 T MRI.the dorsal thalamus could be delineated as early as 14 weeks of GA. The germinal matrix, caudate nucleus,and putamen could be visualized as early as 15 weeks of GA. The globus pallidus could be described as early as 18 weeks of GA.and the internal capsule and external capsule could be shown as early as 20 weeks of GA. The signal of the caudate nucleus during 15-30 weeks of GA was relatively hypointense on T1WI and hyperintense on T2WI.but during 31-40 weeks of GA, it was relatively hyperintense on T1WI and hypointense on T2WI. The putamen had a relatively high signal intensity on T1WI and low signal intemity on T1WI during 15-17 weeks of GA, and it appeared patchy during 18-25 weeks of GA,then it had a relatively low signal intensity on T1WI and high signal intensity on T2WI during 26-30 weeks of GA, and during 31-40 weeks of GA,its signal intensity was relatively high on T1WI and low on T2WI.The globus pallidus had a relatively high signal intensity on T1WI and low signal intensity on T2WI during 20-40 weeks of GA Compared to the 3.0 T MRI,the T2 images of 7.0 T MRl were more clear,and most structures in the region of basal nuclei could be clearly displayed as early as 16 weeks of GA.such as the germinal matrix,caudate nucleus,dorsal thalamus,putamen,globus pallidus,internal capsule,and external capsule.The claustrum could be delineated as early as 18 weeks of GA on 7.0 T MRI. Conclusions 3.0 T MRI could show the developmental process of the region of basal nuclei well,but the T2 images of 7.0 TMRl were comparatively better.