Objective To investigate MRI manifestations of lumbar and proximal femoral bone marrow changes before and after recombinant human granulocyte colony stimulating factor (rhG-CSF) was subcutaneous injected for healthy adults.Methods Twenty healthy blood stem cell donors without hematologic disease were enrolled in this study. All of them underwent lumbar sagittal and proximal femur coronal MRI examination with spin echo T1 WI and fat-suppressed T2WI.The first examination were performed before subcutaneous injection of rhG-CSF for comparison. In 4-7 days and 30-60 days after injection, the other two examinations were performed. The signal changes of lumbar and proximal femoral bone marrow were investigated by reading pictures and calculating the contrasted noise ratio (CNR).ResultsBefore rhG-CSF injection, all patients presented normal signal intensity of hone marrow. In 4-7 days after injection, all the 20 cases presented homogeneous signal decrease in lumbar vertebral bodys on T1 WI, accompanied by reduced fatty signal. In proximal femur, patchy or stripped hypointensity areas were found in intertrochanteric and subtrochanteric areas on T1 WI. On fat-suppressed T2 WI images, the signal of lumbar and proximal femoral bone marrow changed to equal or slightly-high signal intensity. In all cases,abnormal signal areas presented in lumbar and proximal femoral bone marrow occurred simultaneously in the same case.In the 10 cases received the third MRI during 30-60 days after rhG-CSF injection, signal intensity of lumbar bone marrow turned to normal in all sequence, but abnormal signal intensity areas were still existed and extended to distal part in femoral bone marrow, which appeared as symmetric stripped or patchy equal or slightly-low signal intensity on T1 WI and equal or slightly-high signal intensity on T2 WI. The CNR of lumbar bone marrow to subcutaneous fat before rhG-CSF injection, in 4-7 days and 30-60 days after rhG-CSF injection were 114. 11 ± 15. 11,71.04 ± 12. 25 and 91.64 ± 1 I. 68, respectively. Significant difference was found between before rhG-CSF injection and 4-7 days after injection ( P ＜ 0. 05 ) , but no significant difference between the others( P ＞ 0. 05 ). Conclusion After injection of rhG-CSF, the short-term changes of hematopoietic cells and fat content in bone marrow can be displayed on MRI, which provided non-invasive information for bone marrow transplantation.

Objective To evaluate the applied value of multislice CT (MSCT) in the selection of living donor kidneys and excision methods.Methods Ninety living renal donors underwent MSCT assessment.The nonenhanced,arterial,venous and excretory phase examinations were performed.Using maximum intensity projection and volume rendering techniques for vascular imaging,two blinded radiologists independently analyzed and evaluated all MSCT images.According to the CT reconstructive images,radiologists and physicians selected the left renal or the right renal donors,and chose laparoscopic or open live donor nephrectomy.Results On the 90 cases of donors,78 donors underwent nephrectomy in the left kidney.Seventy-one left kidney donors having no significant variation received the routine laparoscopic live donor nephrectomy.Seven left kidney donors on both sides had relatively obvious anatomical variations such as accessory renal artery,multi-branch renal vein and renal vein in the back of the abdominal aorta,and they were subjected to the left kidney open donor nephre.ctomy.Other 12 donors having significant variation in the left kidney were given nephrectomy in the right kidney,and all of them received hand-assisted laparoscopic live donor nephrectomy.All intraoperative records of urine collection system and renal vascular anatomy were consistent with the preoperative evaluation of MSCT,and the accuracy was 100 ％.Two imaging experts in the evaluation of renal artery,renal vein and urine collection system showed good consistency.Nephrectomy was successfully performed on 90 cases of donors,and.postoperative recipients had no renal vein thrombosis and other vascular complications.Conclusion MSCT can provide accurate and valuable information for the selection of living donor kidneys and excision methods as a “one-stop” technique for the preoperative evaluation of living renal donors.

Objective To investigate the clinical features, diagnosis and treatment of cardiac pheochromocytoma. Methods The clinical data of 3 cases (2 males and 1 female) who were 17,40 and 35 years old,respectively,were analyzed.They all presented with headache, sweating, palpitations and hypertension.Before operation 24-hour urinary catecholamine excretion was examined for the 17-year-old man and the woman twice with the results as follows.In the 17-year-old man,epinephrine (E) was 1.84,150.28 ?g/24h (normal range,4.08?2.34 ?g/24h);norepinephrine (NE):734.77,508.00 ?g/24h (normal range,28.67?11.98 ?g/24h);dopamine (DA):823.00,620.31 ?g/24h (normal range,225.76?104.83 ?g/24h).In the woman,E was 12.40,16.03 ?g/24h;NE:1778.92,1243.96 ?g/24h;DA:1517.47,926.89 ?g/24h.All the 3 patients had positive result with Tc-99m-Otretide scintigraphy,and all underwent orthotopic excision of tumors under cardiopulmonary bypass. Results During operation,the tumors of 2-5 cm in size were seen to lie at the base of the aorta,left atrium and interauricular septa respectively,and grew invasively like carpet,thus were difficult to remove. Postoperative pathology of 3 cases confirmed the diagnosis of cardiac pheochromocytoma.After follow-up for 8-24 months,3 cases had a mean fall of 30 mmHg in systolic pressure and 20 mmHg in diastolic pressure,respectively.The 17-year-old man had decline in cardiac function that was proved by Tc-99m-Otretide scintigraphy test;another male patient suffered from arrhythmias 1 month after operation,and was found to have tumor remains by PET test.Myocardial infarction occurred in the female patient. Conclusions Cardiac pheochromocytoma is a rare tumor, and its diagnosis is rather difficult and complex.Surgical excision is very difficult with the possibility of complications.

Objective To investigate the relationship between dynamic changes of plasma D-dimer and survival rate of the esophageal carcinoma patients pre-and post-operation.Methods 30 cases of normal control group,160 cases of esophageal cancer group( including operation cases n =112),with the gold standard method for the determination of plasma D-dimer.Results There was a link between the level of D-dimer,TNM staging,lymph node metastasis and tumor size in esophageal carcinoma patients.Compared with the preoperation,the plasma D-dimer is significantly elevated 2 years later( t =7.35,P ＞ 0.05 ).Conclusion Before or after the operation,dynamic changes of plasma D-dimer had a relationship with short-term survival rate.

Objective To analyze rural doctors′ social mentality with the theory of relative deprivation.Methods 642 rural doctors from 225 villages of 1 5 counties in Shandong were selected for a questionnaire survey.The factor analysis method was used to reduce the scale dimension and simplify the scale.Analysis of rural doctors′vertical and horizontal relative deprivation was made based on different reference groups.Results Rural doctors tend to identify themselves with rural teachers and doctors in township hospitals,and 60.0% identify themselves as the low income group.39.9% of them found a higher income,while 33.5% of them found a higher social status.76.3% of them found their social contributions are higher.91.4% of them hold that villagers benefit from the new healthcare reform policies,while 65.9% of them hold themselves as benefiting from such policies.This indicates a low sense of achievement.Conclusions Compared with the reference groups,rural doctors feel an obvious sense of relative deprivation comparing both horizontally and vertically.They hold themselves as underpaid and have little sense of achievement for the policies.In this consideration,the government should increase subsidies to lift pay for rural doctors,and to identify their legitimacy,in order to stabilize these medical workers.

Objective: To explore the effects of effort-reward imbalance (ERI) at work on the occupational burnout, job satisfaction and turnover intention of doctors in public hospitals. Methods: By using self-designed questionnaires to in-vestigate job attitude, this paper adopts a stratified random sampling method to select 1910 doctors from public hospitals in Jinan, Weifang and Dezhou cities based on the level of economic development in Shandong province. The data are ana-lyzed using descriptive analysis, correlation analysis, hierarchical regression analysis, etc. Results: The effort-reward imbal-ance at work exists in the surveyed public hospitals. The job effort of doctors is 1. 39 ± 0. 37 times higher than job reward. The effort-reward imbalance at work has positive predictive effects on occupational burnout, negative predictive effects on job satis-faction, and positive predictive effects on turnover intention. Conclusions:Public hospital administrators should improve the ef-fort-reward ratio of doctors in order to stabilize doctors' professional attitude at work and enhance their morale.

Grounded theory was used to summarize and analyze influencing factors and their mechanism on availability of essential medicine.Four factors which influenced the availability of essential medicine were singled out:defective top design in the essential medicine system,interactions among its policies,deviations in the policy implementation by government agencies,and deficiency of supporting policies for the system.The availability of essential medicine in rural areas was influenced by a variety of factors.The ideas and methods of the grounded theory prove helpful for this study.In the future studies,both qualitative and quantitative study should be made to perfect this model formed by the grounded theory,to identify roadblocks and underlying causes in order to provide evidence for improving availability of essential medicine in rural areas.

Objective To observe the effect of MG-132 on NF-κB signal path of cartilage and synovium in a rat model of knee osteoarthritis.Methods The rat models of knee osteoarthritis were established by performing anterior cruciate ligament amputation and partial medial meniscectomy.Totally 144 adult SD rats were randomly divided into 4 groups:MG-132 group,100 ml 0.007 g/L MG-132 solution was injected in to the knee joints of rat model 24 h after surgery; DMSO group,100 ml 0.1％ DMSO solution was injected 24 h after surgery; sham surgery group,merely the knee capsulotomy was performed and no solution was injected;control group,100 ml 0.007 g/L MG-132 solution was injected into the knee joints.The cartilage and synovium specimens were obtained at 2,4,12 weeks postoperatively.Pathomorphological observation was taken.The levels of NF-κB p65,I-κB,TNF-α and IL-1β at mRNA were detected by real-time PCR,and the activityof 20S proteasome was measured by fluorospectrophotometry.Resnlts The Mankin score of MG-132 groupwas lower than that of DMSO group.The Mankin scores of sham surgery and control groups were lower thanthose of MG-132 and DMSO groups with significant difference.The mRNA levels of NF-κB p65,IL-1 β,TNF-α of cartilage and synovium in MG-132 group were lower than those of DMSO group with significant differenceexcept for NF-κB p65 of synovium at 2 weeks and IL-1β of cartilage at 12 weeks.The mRNA levels of I-κB of cartilage at 2 weeks and I-κB of synovium at 4 weeks in MG-132 group were higher than those in DMSO group with statistical significance.Conclusion MG-132,the proteasome inhibitor,could postpone the progress of osteoarthritis through alleviating synovial inflammation and defending the articular cartilage.

Objective To evaluate the bonding condition of hydroxyapatite (HA)/zirconia ( ZrO2 ) composite and bone interface and the ability of HA/ZrO2 in repair of bone defects.Methods Bone defect models were established in the lumbar vertebral body of 24 Beagle dogs and were implanted with HA/ZrO2 gradient composite (Group A ),HA/ZrO2 unilayer composite (Group B ),pure ZrO2 (Group C) and pure HA (Group D) successively.Dogs were sacrificed and lumbar vertebral specimens were harvested 6,12,16 weeks postoperatively and before the sacrifice at postoperative 6 and 12 weeks,the dogs were intramuscularly administered of quadracycline for fluorescence labeling.The interface bonding and repair of bone defects were observed through X-ray films,histomorphology and biomechanical test.Results The X-ray films displayed that the Group A achieved more formation of osteotylus and better repair of bone defects with the extension of the implantation period,followed by the Groups B and D and that the Group C had relatively worse results.Histomorphology study showed that the fluorescence labeling was enhanced gradually from 6 to 12 weeks in the Group A,with its growth from the edge of the implanted material to the inner part and its tight adhesion to the material,indicating active osteogenesis and massive bone formation.While the fluorescence labeling of the Groups B,C and D centered in the edge of implanted materials without presence in the material inner part.The mineralization rate of the four materials at 6 and 12 weeks had significant differences ( P ＜ 0.05).Synostosis rates at 6,12 and 16 weeks were the highest in the Group A,with the rate of up to (90.26 ±3.82) ％ at 16 weeks (P ＜0.05 ).Biomechanical test showed the maximum shear strengths at 6,12,16 weeks in the Group A were (2.64±0.16) MPa,(2.95 ±0.19) MPa and (3.45 ±0.23) MPa respectively (P＜0.05).Conclusion HA/ZrO2gradient biocomposite bonds well with the bone and possesses good repair ability for bone defects and hence is an ideal novel material for bone defect reconstruction.

Objective To analyze the outcomes of the subsidy mechanism reform for China's public hospitals through a financial perspective.Methods An evaluation index system was built using data from China's health (family planning) statistics yearbooks 2009-2016, for comparison of the constituent ratio and chain relative ratio growths of public hospitals in various years.Results Year 2015 found a lower growth rate of medical revenues of these hospitals;year-by-year drop of drug income ratio, yet a gradual rise of income from examinations and materials, and a drop of technical service income growth and its ratio of the total income;a year-by-year drop of drug income surplus growth, and an expanding deficit in medical services;a slower growth of medicine expense growth, with the asset-liability ratio rising to 45.3%, and salary ratio rising to 30.6%.Conclusions The reform on compensating mechanism at public hospitals is demonstrating its impacts on public hospitals, namely slower growth of medical revenue, weakened compensating role of drug income, lower surplus, and higher asset-liability ratio among other financial risk exposure.These hospitals are encouraged to take proactive measures to control costs, including tighter medical service cost control,to secure sufficient and timely government fiscal subsidy, and other funding measures to cope with debts of the hospitals.