Objective To investigate the impact of tube current and tube voltage on CT attenuation,the correlation between CT attenuation and iodine concentration,as well as the percentage of reducing dosage for contrast agent while reducing the tube voltage.Methods A total of 100 saline solutions with decreasing dilution of contrast medium,in which concentration was between 0.5 to 50.0 mg/ml with the interval of 0.5 mg/ml,was produced.Each of the 25 syringes with a 4 ml sample was fixed on a cylindrical CT calibrated water phantom with an equal distance used the tape.CT scans were performed with a total of 15 scanning methods of the combination of the different tube voltages (70,80,100,140 kV) and tube current (100,200,280 mA).All of the CT attenuations were measured and recorded.The differences of CT attenuations under different scanning tube currents and tube voltages were compared with one-way ANOVA.The Pearson correlation analysis was used to analyze the relationship between CT attenuation and iodine concentration,and linear correlation equations were calculated and shown by regression analysis.According to the equations,the changes of contrast medium dosage were calculated with the changes of tube voltage.Results There was no significant difference in CT attenuations on different tube currents when the tube voltage was fixed (all P＞0.05),while when the tube current was fixed,the difference of CT attenuations on different tube voltages was statistically significant (all P＜0.05).Under different scanning conditions,the CT attenuations was linearly related to the iodine concentration (r2 was 0.953 to 0.997,all P＜0.01).While the tube voltage was reduced from 140 kV to 120 kV,100 kV,80 kV,70 kV,respectively,the iodine concentration of the samples were reduced by 15.4％,33.7％,53.4％,64.7％ respectively.While the voltage was reduced from 120 kV to 100 kV,80 kV,70 kV,respectively,the iodine concentration were rednced by 21.6％,44.9％,58.2％,respectively.While the voltage was reduced from 100 kV to 80 kV and 70 kV,the iodine concentration was reduced by 29.7％ and 46.7％,respectively.While the voltage was reduced from 80 kV to 70 kV,the iodine concentration was reduced by 24.1％.Conclusion CT attenuation can keep constant in low tube voltage setting by reducing the dosage of contrast agent,which can achieve a low radiation dose and low contrast agent dosage.

Objective To investigate the feasibility of reducing bolus?tracking monitor frequency in coronary CT angiography (CTA). Methods This prospective study including 120 patients with suspected coronary artery disease (CAD). According to the examination registration order, the patients were divided into groups A, B and C (n=40 for each group). All patients underwent coronary CTA with bolus?tracking technology, and were monitored at 10 s after the injection of contrast. The monitoring frequency of bolus?tracking for Group A was every 1.14 s, that for Group B was every 1.47 s , and for Group C was every 2.00 s, while the trigger threshold was set as 100 HU. To evaluate the image quality, the objective evaluation included signal noise ratio (SNR) and contrast noise ratio (CNR) of aorta (AO), CNR of left main coronary artery (LM) and right coronary artery (RCA), and the subjective score was recorded for each coronary artery segment. The monitoring times when CT density of the region of interest (ROI) reached the threshold, the CT value and the effective dose (ED) in the 3 groups were recorded. Objective image quality, monitoring parameters and radiation dose were compared using analysis of variance method, subjective image quality was compared withχ2 tests. Results There was no significant difference in AO (SNR and CNR), LM (CNR) and RCA (CNR) among the 3 groups, respectively (P>0.05). Subjective image quality scores of groups A, B, C were (1.879±0.042), (1.876±0.042), (1.881±0.042 ), with no significant difference (χ2=0.003,P>0.05). The monitoring times of to reach the threshold in groups A, B, C were (4.78±2.37), (3.76±1.39), (2.77±0.99), and ED were (0.058±0.031),(0.031±0.011), (0.021±0.007) mSv, with the significant difference (F=9.009, 31.998, respectively, P<0.01). Peak CT values during monitoring among three groups were (133 ± 24), (142 ± 39), (137±26) HU, respectively, with no significant difference (F=0.575,P=0.565). Conclusions It is feasible to reduce monitoring times when performing coronary CTA in dual?source CT scanner. The bolus?tracking monitor frequency in every 2 seconds can not only obtain satisfactory image quality, but also significantly reduce radiation dose.

ObjectiveTo investigate ultrasonographic signs as the factors for the recurrence of gallstones and polypoid lesion of the gallbla-dder in patients undergoing gallbladder-preserving surgery. MethodsRelated signs including gallbladder size, sound transmission of the gallbladder, gallbladder wall thickness, cholestasis, gallbladder contraction function, and common bile duct diameter measured by preoperative and postoperative ultrasonography, as well as the recurrence of gallstones and polypoid lesions of the gallbladder after surgery, were collected from 700 patients who underwent gallbladder-preserving surgery in Huangshi Central Hospital from January 2011 to February 2015. The Fisher′s exact test and Cox proportional hazards regression model were applied for univariate and multivariate analysis of related factors for recurrence after gallbladder-preserving surgery. ResultsThe shortest and longest follow-up time was 6 months and 48 months, respectively, and the mean follow-up time was 18±12 months. Among the 700 patients, 1 experienced recurrence of gallstones at 1 month after surgery, 2 experienced recurrence of gallstones at 6 months after surgery, 1 experienced recurrence of gallstones at 12 months after surgery, and 1 experienced recurrence of polypoid lesions of the gallbladder at 24 months after surgery. The mean time to recurrence of gallstones and polypoid lesions was 9.8 months after surgery, and the recurrence rate was 0.71% (5/700). The univariate analysis showed that gallbladder wall thickness ≥4 mm, gallbladder contraction function ＜30%, and cholestasis were significantly associated with the recurrence of gallstones and polypoid lesions (all P＜0.05). The multivariate analysis showed that gallbladder wall thickness ≥4 mm, cholestasis, and gallbladder contraction function ＜30% were independent factors for recurrence after gallbladder-preserving surgery (P=0000 3, 0.040 0, and 0.040 0). ConclusionUltrasonography shows that gallbladder wall thickness ≥4 mm, gallbladder contraction function ＜30%, and cholestasis are closely associated with the recurrence of gallstones and polypoid lesions of the gallbladder.

In line with the worldwide trend in population aging, China has stepped into an aging society since 2000. The outstanding features of aging, including a large proportion of the older population, rapid growth, dramatic expansion of the oldest-old, and uneven aging distribution, have put China in a unique position. Besides, older population is expanding in parallel with the escalating burden of disease, high prevalence of disability, and low social involvement. However, China is not prepared to solve these problems in terms of the economy, awareness, geriatric care system, geriatric team, social security, or age-friendly environment. From the perspective of public health, we summarized the major challenges and proposed the following policy recommendations: (1) strengthening the top-level design and building a "government-leading, multi-sectoral-cooperating, and society-participating" pattern; (2) enhancing health services by implementing the "comprehensive health" strategy; (3) developing home and community care, coordinately enhance institutional care, promote integration of medical and care systems, and establish a multidimensional tailored care system; (4) optimizing geriatric the supporting system, included the construction of geriatric team and the long-term care insurance system; and (5) establishing a physical and socially age-friendly environment.

BACKGROUND AND OBJECTIVES: Even short-term treatment with angiotensin converting enzyme inhibitor in essential hypertension has been known to improve left ventricular (LV) diastolic function, LV hypertrophy (LVH), and aortic stiffness. The purpose of this study was to examine the effects of angiotensin II receptor antagonist (Losartan) on LV diastolic function, LVH, and aortic stiffness in essential hypertension. MATERIALS AND METHODS: Twenty-three hypertensive patients who were aged over 50 years, previously untreated, and without cardiac, renal, neurologic disease, or diabetes, were studied. Before and 12 weeks after monotherapy with Losartan 50 mg q.d., (1) supine arterial blood pressure by sphygmomanometry, (2) interventricular septum and LV posterior wall thickness, and LV end-diastolic dimension by M-mode echocardiography, (3) mitral peak E and A wave velocity by doppler echocardiography, (4) pulse wave velocity (PWV) in the descending aorta from aortic arch to the bifurcation by doppler echocardiography, were done. RESULTS: Twelve weeks after treatment, systolic blood pressure was lowered from 168.2+/-3.5 mmHg to 142.9+/-2.9 mmHg (p<0.05), diastolic blood pressure from 98.52.4 mmHg to 87.51.3 mmHg (p<0.05). Peak E/A ratio was increased from 0.75+/-0.04 to 0.82+/-0.04 (p<0.05). LV mass was decreased from 267.5+/-15.8 g to 235.6+/-12.6 g (p<0.05), and LV mass index from 166.8+/-8.0 g/m2 to 146.9+/-6.0 g/m2 (p<0.05). However, there were no significant change in PWV (from 7.18+/-0.10 m/sec to 7.23+/-0.30 m/sec, p>0.05), compliance (from 1.31+/-0.04 to 1.34+/-0.12, p>0.05), and compliance index (from 0.16+/-0.01 to 0.15+/-0.01, p>0.05). CONCLUSION: Short-term treatment with Losartan decreases blood pressure, improves LV diastolic function and LVH, but not aortic stiffness.
Angiotensin II* ; Angiotensins* ; Aorta, Thoracic ; Arterial Pressure ; Blood Pressure ; Compliance ; Echocardiography ; Echocardiography, Doppler ; Humans ; Hypertension ; Hypertrophy ; Losartan* ; Peptidyl-Dipeptidase A ; Pulse Wave Analysis ; Receptors, Angiotensin ; Vascular Stiffness* ; Ventricular Function, Left*

Objective:To investigate the expression levels and clinical significance of glioma-associated oncogene homolog 1 (GLI1) and sonic hedgehog signaling molecule (Shh) in the malignant transformation of ovarian endometriosis (EM).Methods:The expressions of GLI1 and Shh were detected by real-time reverse transcription (RT)-polymerase chain reaction (PCR) and EnVision method in 50 cases of ovarian EM tissues, 35 cases of atypical endometriosis (aEM) and 50 cases of endometriosis-associated ovarian cancer (EAOC). The expression differences of two molecular markers in the malignant transformation of ovarian EM were compared, and the relationships between two molecular markers and the clinicopathological features and prognosis of EAOC were analyzed.Results:(1) RT-PCR showed that the expression levels of GLI1 mRNA in EM, aEM and EAOC group were 1.77±0.40, 3.54±0.44, and 7.80±0.24, respectively. The expression levels of Shh mRNA were 0.95±0.21, 3.14±0.35, and 5.41±0.31, respectively. GLI1 and Shh mRNA in EAOC group were significantly higher than those in EM and aEM group (all P<0.01), and there were statistically significant differences between EM and aEM group (all P<0.01). The percentages of GLI1 in ovarian EM, aEM and EAOC were 32% (16/50), 57% (20/35), and 66% (33/50), respectively, meanwhile, the positive expression rates of Shh were 20% (10/50), 49% (17/35), and 54% (27/50), respectively (all P<0.01). GLI1 mRNA expression was positively correlated with Shh mRNA expression in EAOC tissues ( r=0.721, P<0.01). The expressions of GLI1 protein were proportionated to Shh protein in EAOC tissues ( r=0.608, P=0.001). (2) The expression of GLI1 was significantly related to the International Federation of Gynecology and Obstetrics (FIGO) stage, cancer antigen 125 (CA 125) levels, lymph node metastasis, and Platinum resistance in EAOC patients (all P<0.05). The expression of Shh were related to FIGO stage and lymph node metastasis in EAOC patients (all P<0.05). Logistic regression analysis showed that GLI1 expression was an independent risk factor for poor prognosis in EAOC patients ( P<0.05). Kaplan-meier survival analysis showed that the overall survival rate of EAOC patients with high GLI1 expression and low GLI1 expression was 12.1% and 35.3%, respectively, with statistical significance ( χ2=10.73, P<0.01). The overall survival rate of EAOC patients with high and low expression of Shh protein was 11.1% and 30.4%, in which there was statistically significant difference ( χ2=3.96, P=0.047). Conclusion:GLI1 and Shh are highly associated with the malignant transformation of ovarian EM, which may play a role in promoting malignant degeneration of ovarian EM, and the high expression of GLI1 and Shh indicates a poor prognosis in EAOC patients.

Cannula ; Catheters ; Drainage ; Duodenal Diseases ; Humans ; Intestinal Fistula/surgery*

Objective To investigate the distribution features of TCM patterns and differentiation method of thyroid cancer through cluster analysis on data of TCM four examinations after surgery.Methods The data of TCM four examinations were collected from 304 patients by applying cross-section epidemiological survey,and then given quantitative classification and a database was established.The quantitative scores of each patient were given cluster analysis by using sample clustering analysis method (Q clustering) for getting the proportion of each category of four examination information.The preliminary criterion for patterns of thyroid cancer was made according to the proportion of four examinations information and expert survey of Delphi method at earlier stage,which was combined with clinical practice to determine the patterns.Results All 304 patients were clustered into 9 categories indicated by from A1 to A9.The frequency of A1 was 77 cases;A2,7;A3,1;A4,7;A5,105;A6,7;A7,87;A8,11 and A9,2.Based on clinical practice and experts' experiences,A1 and A7,A5 and A6,and A3 and A4 were merged and evaluated respectively as pattern of dual deficiency of qi and yin (164 cases,53.9％),pattern of liver depression and qi stagnation (112 cases,36.8％) and spleen-kidney yang deficiency pattern (8 cases,2.6％).A2 was evaluated as pattern of yin damaged by stasis heat (7 cases,2.3％).The proportions of four examination information of A8 and A9 were disperse and evaluated as other patterns (13 cases,4.4％).Conclusion The distribution of TCM patterns in the patients with thyroid cancer after surgery has its regularity.It is feasible to evaluate TCM patterns with cluster analysis combining with experts' experiences.

Objective:To identify the differentially expressed proteins that caused hippocampal damage after liver ischemia-reperfusion (I/R) in rats.Methods:Eighteen clean-grade healthy juvenile male Sprague-Dawley rats, aged 2 weeks, weighing 20-30 g, were divided into 2 groups ( n=9 each) using a random number table method: sham operation group (S group) and liver I/R group (IR group). A rat model of liver I/R injury was prepared by restoring perfusion after 1 h of liver ischemia. The rats were sacrificed after being anesthetized at day 3 of reperfusion, and the hippocampal tissue was isolated and analyzed to obtain gene expression profiles. Differentially expressed genes were identified using the R software, and further protein interaction networks were constructed through Cytoscape and Kyoto Encyclopedia Genes and Genomes pathway analysis to determine the differentially expressed proteins. Quantitative real-time polymerase chain reaction and Western blot were used for validation. Results:A total of 45 differentially expressed proteins were identified by the proteomic analysis of hippocampal tissues, including 36 significantly up-regulated proteins and 9 significantly down-regulated proteins. The proteins with significant expression related to injury were identified from the PPI network complex using the CytoHubBA plug-in cystscape: Ras-related C3 botulinum toxin substrate (RAC2), HRAS, phosphatidylinositol-3-kinase inhibitor phosphatase and tensin homologue (PTEN), and N-methyl-D-aspartate ionotropic glutamate receptor 2b (GRIN2b). The results of quantitative real-time polymerase chain reaction and Western blot showed that the expression of RAC2, HRAS, PTEN, and GRIN2b in the hippocampal tissue was significantly up-regulated in IR group compared with S group ( P<0.05). The results of Kyoto Encyclopedia of Genes and Genomes pathway analysis showed that differentially expressed proteins were significantly enriched in the expression of PD-L1 and its checkpoint pathway, long-term potentiation, and regulation of the Wnt signaling pathway in cancer. Conclusions:The mechanism by which liver I/R induces hippocampal injury may be related to the up-regulation of the expression of RAC2, HRAS, PTEN and GRIN2b in rats.

Objective To observe the application effect of a quantitative nursing management program in the operating room constructed based on risk assessment strategies for patients with osteochondroma. Methods Thirty patients who underwent osteochondroma surgery from July 2021 to June 2022 at Suqian Hospital Affiliated to Xuzhou Medical University were set as control group (receiving conventional nursing management), and 30 patients who underwent osteochondroma surgery from July 2022 to June 2023 were set as study group (receiving quantitative nursing management centered on risk assessment strategies). The perioperative indicators, psychological stress status, self-care ability, quality of life, and complication occurrence were compared between the two groups. Results The recovery time of gastrointestinal function, postoperative anal exhaust time, and hospital stay in the study group were (0.72±0.12), (1.71±0.32), and (21.32±3.47) days, respectively, which were shorter than (1.04±0.28), (2.02±0.42), and (28.02±4.02) days in the control group (P < 0.05). After nursing, the scores of the Self-rating Depression Scale and Self-rating Anxiety Scale in the study group were (36.87±5.64) and (32.42±6.82), respectively, which were lower than those (45.24±6.32) and (48.33±6.56) in the control group (P < 0.05). After nursing, the total scores of the Exercise of Self-Care Agency Scale (ESCA) and SF-36 Scale in the study group were (142.87±15.62) and (86.42±7.28), respectively, which were higher than (125.42±16.32) and (78.33±8.56) in the control group (P < 0.05). The total complication rate in the study group was 6.67%, which was lower than 26.67% in the control group (P < 0.05). Conclusion The quantitative nursing management program in the operating room constructed centered on risk assessment strategies can effectively improve the postoperative recovery effect of patients with osteochondroma, relieve psychological stress responses, enhance self-care ability and quality of life, and reduce the occurrence of complications.