Objective To evaluate the appropriateness of hospitalization days at a tertiary hospital in 2014 by means of the Appropriateness Evaluation Protocol ( AEP ) , and to analyze the causes of inappropriate stays. Methods Medical records of inpatients admitted at a tertiary hospital in 2014 were randomly selected. AEP( US version) was used to evaluate the appropriateness of every hospitalization day, while the causes of inappropriate hospitalization day were also analyzed. Results A total of 1 641 days of stay from 148 medical records were reviewed, and 129 days of stay (7. 9%) were seen as inappropriate. Two major factors for inappropriate stays were waiting for surgery and waiting for test, roughly 89. 1% of the inappropriate hospitalization days. The proportion of inappropriate hospital stays reduced to 4. 8% after adjustment of two-day weekend. Inappropriate hospital stays mostly appeared during the second day to the eighth day after admission(93. 8%). Logistic analysis results showed that with concomitant symptoms, preoperative waiting days > 5 days, high level surgery, non-emergency admission were significantly associated with appropriateness of hospital stays (P<0. 05). Conclusions The rate of inappropriate stays will be reduced and the quality of medical services will be improved if comprehensive measures could be carried out according to the causes of inappropriate stays.

ObjectiveTo investigate the concentration of water fluoride and the application of water defluoridation projects in Suizhou,and to provide a basis for water improvement and prevention of the disease.MethodsCross-sectional study was carried out to investigate completely the water defluoridation projects built between 1986 and 2009 in the area under Suizhou's jurisdiction; 3 source water and terminal water samples of the projects in use were collected,respectively; 1 water sample was collected,respectively in the 3 projects with out-ofcommission or discarded water sources that used to be major water supply,for detection of fluoride,chloride,total hardness,heavy metals and other indicators.ResultsA total of 21 projects were investigated,14 projects were in normal use (66.7％),7 projects were out of order and abandoned (33.3％).Of the 14 projects normally used,13projects with water fluoride concentration ≤ 1.0 mg/L(92.9％)and 1 project with water fluoride concentration higher than 1.0 mg/L(7.1％),the concentration of water fluoride in the 7 abandoned projects was higher than 1.0 mg/L(100％).Arsenic and lead levels of all the water samples were normal.There were two water samples with iron content exceeded the standard,and one total hardness of water samples exceeded the standard in the normally used 14 peripheral water sources.One chloride content exceeded the standard,one manganese content exceeded the standard,two iron content exceeded the standard and three total hardness exceeded the standard in the seven abandoned projects.ConclusionsSome defluoridation projects are stopped using and abandoned in Suizhou,and the water fluoride exceeds the standard.

Objective To investigate a shorter and safer route for contralateral C_7 nerve root transfer. Methods Eight male patients were treated from Dec2005 to Nov.2006Their range of age was from 22 to 43 years with an average of 30 yearsFive cases had total brachial plexus avulsion.The operative delay was from 2 to 6 months(mean:4 months).The sealenus anterior muscle was transected before a prespinaJ & ret- ropharyngeal tunnel was madeThe contralateral C_7 nerve root was used to repair the upper trunk or the infra- clavicular lateral cord and posterior cord of injured side via this routeusing direct anastomosis or nerve graft- ing.Results The length of the harvested contralateral C_7 nerve root was(4.67?0.52em in the early 5 casesThe nerve graft was6.25?0.35)em long for repairing supraclavicular brachial plexus and(8.56?0.45cm long for repairing infraclavicular brachial plexusThe length of the harvested contralateral C_7 nerve root averaged 6.85cm in the other 3 cases2 of which had direct anastomosis to the residual nerve C_5 and C_6 nerve roots and the other used nerve graft of 3 cm in lengthTransient contralateral sensory symptoms were re- ported in most patientsAt 3 months followups6 patients had tingling sensation on the contralateral fingers with percussion on the injured cervical areaIpsilateral SSEP could be recorded by stimulating at 2 cm above sternoclavicular joint on the injured sideAt 7 months follow ups of 5 patientsCMAP could be recorded in bi- cepsdeltoids and infraspinatus or triceps with stimulation at Erb's pointHoweverno clinical movements was noticedAt 12 months follow ups of 3 patientswe could observe early motor and sensory function recovery of those patients to different extent.Conclusion Transection of anterior scalenus muscle shortens the length of the transfer route and allows more efficient neurotizationThe procedure is convenient and safeprovided certain precautions being usedThe principal of contralateral C_7 nerve transfer are reconstruct the anterior divi- sions of upper trunkposterior divisions of upper trunk and suprascapular nerve when repairing the supraclavic- ula brachial plexusReconstruct the lateral cord and posterior cord when repairing the infraclavicula brachial plexusPostsurgical fasting for 4 days included foods and liquids will benefit of healing of anastomosed nerves and regenerationaud avoid complications.

AIMTo study the antidiabetic effects of cortex Moutan polysaccharide-2b (CMP-2b) in type 2 diabetes mellitus (T2DM) rats.

METHODSThe T2DM model rats were induced by a single intravenous injection of low dose streptozotocin (STZ) and intake of high sucrose-fat diet. CMP-2b was given to T2DM rats daily through gavage for 4-5 weeks. The body weight, water and food intake, fasting blood glucose (FBG), glucose tolerance, plasma lipids, serum insulin, and insulin receptor (Ins R) were determined.

RESULTSOral administration of CMP-2b significantly decreased water and food intake, FBG, total cholesterol (Tch), and triglyceride (TG), improved the impaired glucose tolerance (IGT), and remarkably raised the number of low affinity InsR and insulin sensitivity index (ISI) in T2DM rats.

CONCLUSIONCMP-2b may be useful for treating T2DM and its complications.

Animals ; Blood Glucose ; metabolism ; Body Weight ; drug effects ; Diabetes Mellitus, Experimental ; drug therapy ; Drugs, Chinese Herbal ; chemistry ; Glucose Intolerance ; Hypoglycemic Agents ; isolation & purification ; therapeutic use ; Insulin ; blood ; Liver ; metabolism ; Male ; Paeonia ; chemistry ; Plant Roots ; chemistry ; Plants, Medicinal ; chemistry ; Polysaccharides ; isolation & purification ; therapeutic use ; Rats ; Rats, Wistar ; Receptor, Insulin ; metabolism

OBJECTIVETo identify antigens which may help evaluate the therapeutic effect of angiostrongyliasis from adult worm antigen of Angiostrongylus cantonensis.

METHODSThe adult worm antigens of A. cantonensis were analyzed by Western blotting with the sera of rats infected with A. cantonensis before and after treatment. The sera of rats were tested by enzyme-linked immunosorbent assay (ELISA).

RESULTSThe antigens with relative molecular mass between 38,000 and 78,000 reacted not only with the sera of rats before treatment, but also with that after treatment. The antigens with M(r) between 190,000 and 17,000 reacted with the sera of rats before treatment but not with that after treatment; those with M(r) between 32,000 and 24,000 antigens strongly reacted with the former, but the reaction became much weakened with the latter. The AC32-IgG antibody appeared earlier than the AC-IgG, and disappeared rapidly after treatment. Six of the 10 treated rats became negative for AC-IgG as found by ELISA.

CONCLUSIONThe antigens of adult worm antigen of A. cantonensis with M(r) of 190,000, 32,000, 24,000, 17,000 and 16,000 may serve as candidate antigens for therapeutic effect evaluation of angiostrongyliasis.

Angiostrongylus cantonensis ; immunology ; isolation & purification ; Animals ; Antibodies, Helminth ; blood ; Antigens, Helminth ; blood ; immunology ; isolation & purification ; Blotting, Western ; Enzyme-Linked Immunosorbent Assay ; Rats ; Rats, Sprague-Dawley ; Strongylida Infections ; diagnosis ; immunology ; parasitology

OBJECTIVETo investigate the protective effect and mechanism of Shenqi Compound on diabetic angiopathy modeled rats.

METHODSTotally 18 SD rats were randomized into 3 groups, i.e., the normal control group, the diabetic mellitus (DM) group, and Shenqi Compound group, 6 in each group. The DM rat model was established by feeding high-fat diet (to induce hyperlipidemia) +intraperitoneal injection of small dose streptozotocin (STZ). Shenqi Compound was given to rats in the Shenqi Compound group at the daily dose of 2 g/kg. Equal volume of normal saline was given to rats in the model group and the normal control group by gastrogavage. All treatment was lasted for 12 weeks. Then 2-D and ultrasonic integrated backscatter technique were used to evaluate structural and functional changes of abdominal aorta in the progression of diabetic macroangiopathy. The fibrosis degree of the aorta vessel and myocardium capillaries were observed by using HE and Masson trichrome staining. The tension of the aortic vascular ring was determined. The transforming growth factor beta (TGF-beta) mRNA expression was detected by real time PCR (RT-PCR). The protein expression of TGF-beta, collagen I, collagen III, connective tissue growth factor (CTGF), and phosphorylation P38 MAPK were detected by Western blot.

RESULTSCompared with the normal control group, abdominal aortic systolic inner diameter, diastolic inner diameter, Peterson elastic modulus, stiffness index, and backscatter integral significantly increased; the rangeability of integral backscatter and the extension coefficient of cross section significantly decreased in the DM group (all P < 0.05). After 12 weeks aforesaid indices were obviously improved in the Shenqi Compound group (P < 0.05). Results of HE and Masson staining showed that the fibrosis degree of the aorta vessel and myocardium capillaries was obviously alleviated in rats of the Shenqi Compound group (P < 0.05). Results of the aortic vascular ring tension showed that acetylcholine induced vasodilatation and maximum diastolic percent were obviously elevated in the Shenqi Compound group (P < 0.05). Compared with the normal control group, the mRNA expression of TGF-beta, and the protein expression of TGF-beta, collagen I, and collagen III, and phosphorylation of P38 MAPK all significantly increased in the DM group (P < 0.05). Compared with the DM group, the mRNA expression of TGF-beta, and the protein expression of TGF-beta, collagen I, and collagen III, and phosphorylation of P38 MAPK all decreased (P < 0.05).

CONCLUSIONSShenqi Compound could effectively improve the arterial function in diabetic marcoangiopathy and microvascular dysfunction. The mechanism might be due to the down-regulating the expression of TGF-beta, and further suppressing the phosphorylation of P38 MAPK, reducing the synthesis of collagen I and collagen III, therefore, ameliorating arterial and myocardial interstitial fibrosis.

Animals ; Collagen Type I ; metabolism ; Collagen Type III ; metabolism ; Diabetes Mellitus, Experimental ; drug therapy ; Diabetic Angiopathies ; prevention & control ; Drugs, Chinese Herbal ; pharmacology ; Male ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta1 ; metabolism ; p38 Mitogen-Activated Protein Kinases ; metabolism

Objective To investigate the cerebral blood flow (CBF) perfusion patterns and related factors in hyperthyroidism patients.Methods Twenty-five patients with hyperthyroidism and twenty-two healthy controls matched for age,sex,education were enrolled.~(99)Tc~m-ethylene cysteinate dimer (ECD) SPECT CBF perfusion imaging was performed at rest.Statistical parametric mapping 5.0 software (SPM5) was used and a statistical threshold of P＜0.05 (corrected) was applied for signifying changes of regional CBF (rCBF).The semiquantitative values of rCBF were extracted automatically by brain search 1.1 software and were correlated with concentrations of serum thyroid hormones(FT_3,FT_4),thyroid autoimmune antibodies:sensitive thyroid stimulating hormone(sTSH),thyroid peroxidase antibody (TPOAb) and TSH receptor antibody (TRAb) by Pearson analysis,with disease duration by Spearman analysis.Results rCBF was decreased significantly in limbic system and frontal lobe,including parahippocampal gyrus,uncus (posterior entorhinal cortex,posterior parolfactory cortex,parahippocampal cortex,anterior cingulate,right inferior temporal gyrus),left hypothalamus and caudate nucleus (P＜0.05,corrected).rCBF in left lingual gyrus,posterior cingulated was negatively correlated with concentration of FT_3(r=-0.468,-0.417,both P＜0.05).rCBF in left lingual gyrus,bilateral inferior temporal gyrus,right superior parietal lobe was negatively correlated with concentration of FT_4(r=-0.4M,-0.418,-0.415,-0.459,all P＜0.05),while that in left mammillary body and putamen was positively correlated with concentration of FT_4(r=0.419,0.412,both P＜0.05).rCBF in left insula was negatively correlated with concentration of sTSH,and right auditory associated cortex was positively correlated with concentration of sTSH(r=-0.504,0.429,both P＜0.05).rCBF in left middle temporal gyrus,left angular gyrus was positively correlated with concentration of TRAb while that in right thalamus,right hypothalamus,left anterior nucleus,left ventralis nucleus was negatively correlated with concentration of TRAb(r=0.750,0.862,-0.691,-0.835,-0.713,-0.759,all P＜0.05).rCBF in right anterior cingulate,right cuneus,right rectus gyrus,right superior marginal gyrus was positively correlated with concentration of TPOAb(r=0.696,0.581,0.779,0.683,all P＜0.05).rCBF in postcentral gyrus,temporal gyrus,left superior marginal gyrus and auditory associated cortex was positively correlated with disease duration(r=0.502,0.457,0.524,0.440,all P＜0.05).Conclusion Hypoperfusions in limbic system and fontal lobe were found in hyperthyroidism Patients,which might be associated with thyroid function and disesse duration.

Objective To investigate the added diagnostic value of SPECT/CT imaging over routine planar whole-body bone scintigraphy (WBBS) for bone metastases from lung cancer. Methods One hundred and forty-six patients with lung cancer, confirmed by pathological examination, underwent routine 99Tcm-MDP (1110 MBq) WBBS, followed by SPECT/CT over the regions with indeterminate findings on WBBS. Both WBBS and bone SPECT/CT images were interpreted by two experienced nuclear medicine physicians in consensus as the positive, negative or uncertain bone metastases. The final diagnosis was comfirmed by pathology or clinical follow-up. x2 test was used to compare the differences between the two imaging methods. Results Finally, 45 patients were diagnosed as positive bone metastases and the other 101 as negative. The diagnostic sensitivity of bone SPECT/CT for bone metastases from lung cancer was 93.3%(42/45), singnificantly higher than that of WBBS (64.4%, 29/45) (x2 = 19.944, P＜0.05). The diagnostic accuracy of bone SPECT/CT was 89.7% ( 131/146), much higher than that of WBBS (44.5%,65/146) ( x2 = 69. 598,P ＜ 0.05). The uncertain and incorrect diagnostic rates of bone SPECT/CT and WBBS were 10.3% ( 15/146, raging from 5.3% to 15.2% with 95% confidence interval (CI) ) and 55.5% (81/146, raging from 47. 4% to 63.5% with95% CI), respectively. Conclusion BoneSPECT/CT provides incremental diagnostic value over routine WBBS for bone metastases from lung cancer.

Objective To investigate the additional diagnostic value of 99Tcm-MDP SPECT/CT over conventional SPECT scan in patients with spinal bone malignancy. Methods Fifty-two patients (mean age (56±14) years) with suspicious spinal bone diseases underwent both bone SPECT and SPECT/CT imaging right after 99Tcm-MDP whole-body planar bone scintigraphy. All patients were pathologically diagnosed by either spine operation or trans-spinal biopsy. The images were evaluated by two independent reviewers; inter-reviewer agreement was evaluated using a weighted Kappa score. Each focus of abnormality was recorded using a 4-point diagnostic confidence scale: benign (B), possibly benign (PB), possibly malignant (PM) or malignant (M). Results Accord to the pathological results, 36 patients had bone malignancy (19 with metastatic tumors and 17 with non-metastatic tumors) and 16 had benign lesions. Over SPECT images, two reviewers rated 73.1% (38/52) and 67.3% (35/52) the lesions as the equivocal (PB or PM) respectively. Over SPECT/CT images, they rated only 25.0% (13/52) and 13.5% (7/52) lesions as the equivocal. Inter-reviewer agreement was 63.5% (weighted Kappa score=0.62) for SPECT and 78.9% (weighted Kappa score=0.81) for SPECT/CT. Conclusions Compared with99Tcm-MDP SPECT, 99Tcm-MDP SPECT/CT results in a significant reduction of equivocal diagnoses for the spinal bone malignancy.

ObjectiveTo study the relationship between tumor siza,aource intensita,arescription dose and source dwell time in the after-loading treatment plaa,and to establish a method that can be used for rapid quality control of after-loading plans.Methods The all of gynecological cancer patients treated in this hospital were selected:84 cases of all three tubes of Fletcher applicator,58 cases of uterine alone and 39 cases of vaginal applicator.Each patient was scanned with CT before treatment.Contouring the target and organs at risa,ahe treatment plan was optimized using IPSA.Record the source strengta,arescription dosa,aource dwell tima,and tumor volume of the prescribed dose for each case.Calculate CI values and Rv.The kvalue analyzes the CI distribution characteristics and the correlation with the Rv value.In addition,46 cases of gynecologic tumor patients were used to verify the method.Results The fitting index of the after-loading scheme of the three applicators showed a normal distribution.The mean value of the Fletcher applicator CI was 0.720±0.067,the k value was 1 394,Rvalue was 0.894.The mean value of the uterine alone CI was 0.697±0.076,the k value was 1 428,R=0.940,the mean value of the vaginal applicator CI was 0.742± 0.067,the k value was 1 362,and R=0.909.Conclusions Using this methoa,at can quickly assess whether the planned target voluma,aadiation source intensita,arescription dose and treatment time matca,and find the cause of deviation based on the feedback results to ensure that the after-loading treatment plan can be quickla,accuratela,and efficiently implemented according to clinical requirements.