Objective To study the value of CT angiography(CTA) and three dimensional contrast enhanced magnetic resonance angiography(3D CE-MRA) in the diagnosis of arteriosclerotic occlusive disease (ASO) of lower limb and evaluate arterial stenosis. Methods Thirty-eight patients clinically suspected ASO were studied with CTA and3D CE-MRA,twenty-two patients underwent DSA at the same time. The degree of seriousness of the stenosis shown by various imaging techniques were analyzed respectively. Results Using the DSA images as the standard reference, the sensitivity and specificity of CTA were 97.3% ,99. 1%, and MRA both were 100.0% in detecting the segments occluded. With regard the detection of segments that had more than moderate stenosis ,the sensitivity and specificity of CT were 99.3% ,97.6% ,and MRA were 97.9% ,96.4%. The degree of seriousness of the stenosis shown by MRA was overestimated than CTA on the segments that had more than moderate stenosis(x2 =5.80,P ＜0. 05). Conclusion CTA and 3D CE-MRA were reliable method in diagnosis of ASO.

This paper summarizes the nursing care of a child with hand,food and mouth disease complicating multiple organ failure,such as use of ice-blanket and strategies of vessel protection. As a result,the child recovered well and was discharged after rehabilitation.

Objective To investigate the functional characters of traumatic brain injuries occurred in wenehuan earthquake.Methods Thirty-eight cases with brain injury,occurred in Wenchuan earthquake,hospitalized in intensive care unit and brain surgery wards of Wenchuan China Hospital were enrolled in the study.Glasglow coma scale(GCS)was used to assess the severity of brain injury,mini-mental state examination(M MSE)was used to assess the cognitive function,the modified Ashworth scale was applied to aSSeSS the muscle tone,the Bobath balance scale was applied to assess the sitting and standing balance.the modified Barthel index Was applied to evaluate the activities of daily living(ADL).Resuits Mean age of the patients was 46 years,ratio of male to female was 1.9:1.Twenty-seven(71.1%)patients suffered mild brain injury,4(10.5%)patients moderate brain injury and 7(18.4%)patients severe brain injury.In non-comatose patients,some patients suffered motor control disorder as hemiplegia,aphasia,cognitive disorder,Rom limitation,muscle tone disorder,muscle weakness,sitting balance disorder and standing balance disorder respectively.Thirty-six(94.7%)patients couldn't take care of themselves independently.Conclusion The function disorder of traumatic brain injuries occurred in earthquake had some particular characteristics.it's necessary to establish a rehabilitation system for the effectire rehabilitation management and treatment according tO the patients'characteristics.

Objective To evaluate the advantage of single -source spectrum CT in differentiating of calcifi-cation and tophus.Methods 146 cases of clinical suspected patients with gout pain were scaned by single -source spectrum CT,observed the adjacent to the bone and joint hyperplasia and showing characteristics of gout stone,coun-ted quantity,size and position of the sedimentary tophus.Diagnosed by American rheumatism association standard as the gold standard,computed the sensitivity,specific degrees and accuracy of showing tophus of single -source spec-trum CT and conventional CT,and evaluated the advantage of differentiating adjacent to the bone and joint hyperplasia and gout stone of single -source spectrum CT.Results Diagnosis of gout in 105 cases.Scaned 349 joints,positive in 341 of them,The first plantar toe joint involvement was obvious[118,34.60%(118/341)];The result showed that the sensitivities of the tophus,specific and accurate rate of the conventional CT were 63.80%(67 /105),65.85%(27 /41),64.38%(94 /146),which of single -source spectrum CT were 96.19%(101 /105),87.80%(36 /41), 93.84%(137/146),the differences of sensitivity,specificity and accuracy between the two methods were statistical significance(χ2 =34.42,555,38.34,all P <0.05).Conclusion Single -source spectrum CT in gout stone adjacent to the bone and joint has higher sensitivity and accuracy,specific degree,it is higher than conventional CT and provide a new noninvasive imaging technique for the identification of the peripheral bone and joint of the bone.

Objective To explore the effects of Sanban manipulation of spine on ankylosing spondylitis (AS) at the early-middle stage.Methods 60 AS patients at the early-middle stage were divided into drug group (n=30) and manipulation group (n=30). The drug group wastreated with sulfasalazine and the sustained-release pills of Zhengqingfengtongning, while the manipulation group were treated with Sanbanmanipulation of spine additionally. Self-developed questionnaire were used to follow up before and 1, 3 and 6 months after treatment. ResultsThe Schober index and the finger-floor distance improved more in the manipulation group than in the drug group (P<0.05) 3 months aftertreatment. All the index improved more in the manipulation group than in the drug group (P<0.05) 6 months after treatment. ConclusionSanban manipulation of spine can improve the thoracolumbar activities in the AS patients at the early-middle stage.

Objective To evaluate the relationship between sternum protection and bone marrow suppression in postoperative radiotherapy for esophageal carcinoma. Methods Total of 98 postoperative patients with thoracic esophageal carcinoma were randomly divided into experimental group (52 cases) and control group (46 cases). All patients were given intensity-modulated radiotherapy (IMRT), with the dose of 50-50.4 Gy. The patients in experimental group were irradiated by 6 fields (4-fields in front, 2-fields behind) which were crossed to avoid direct exposure to the sternum. The patients in control group were irradiated by 5 fields (3-fields in front, 2-fields behind) with front-middle of the field passing through the sternum. Concurrently all patients received 2 cycles of cisplatin chemotherapy. Results Dmean, V20 and V30 of the sternum in the experimental group were (20.21 ±3.60) Gy, (40.78 ±7.19) % and (33.78 ±9.44) %, which were lower than those in the control group [(30.91±5.21) Gy, (81.01±4.81) %, (51.60±6.84) %], respectively (P<0.05). However, the volume and dose distribution of lung, spinal cord and heart were similar between the two groups (P> 0.05). Both the incidence rates of bone marrow suppression at 14th day and 35th day after radiotherapy were significantly higher in the control group (52.2%, 73.9%) than those in the experimental group (28.8 %, 50.0 %) (P< 0.05), and the incidence rate of bone marrow suppression at 7th day after radiotherapy was similar between the two groups. Conclusion Protecting and sketching for sternum in postoperative radiotherapy for esophageal carcinoma can reduce the incidence of bone marrow suppression effectively, which would not increase the radiation dose in the lung, heart and spinal cord.

Objective To study antimicrobial resistance and genotyping of methicillin-resistant Staphylococcus au-reus(MRSA). Methods A total of 967 no-repetitive strains of Staphylococcus aureus(S.aureus)isolated from a hospital between January 2014 and November 2015 were collected,antimicrobial susceptibility testing,mecA gene,and Panton-Valentine leukocidin gene(PVL gene)were detected;staphylococcal cassette chromosome mec(SCCmec)typing,multilocus sequence typing(MLST),S.aureus protein A(spa)gene typing,and S.aureus ac-cessory gene regulator(agr)typing were performed with multiplex polymerase chain reaction. Results Of 967 strains of S.aureus,210(21.72%)were MRSA;detection rate of MRSA from sputum specimen was higher than that of skin and soft tissue specimen(68.09% vs 1 1.83% ,P<0.05);vancomycin- and linezolid-resistant S.aureus strains were not found,susceptibility rates of MRSA to gentamicin,tetracycline,erythromycin,clindamycin,levo-floxacin,ciprofloxacin,moxifloxacin,nitrofurantoin,and rifampicin were all lower than those of methicillin-sensi-tive Staphylococcus aureus(MSSA),differences were all statistically significant(all P<0.05);antimicrobial sus-ceptibility rate of MRSA to compound sulfamethoxazole was higher than MSSA,difference was significant(P<0.05). Susceptibility rates of MRSA isolated from skin and soft tissue to gentamicin,levofloxacin,ciprofloxacin,moxifloxacin,and rifampicin were 86.90% -95.24%,while MRSA isolated from sputum were only 1.56% -15.63%.Of 967 strains of S.aureus,210 harbored mecA gene,10 harbored PVL gene,8(3.81%)of 210 MRSA strains weren't typed. The main types of MLST,SCCmec,spa,and agr were ST 239(n= 177 strains),type Ⅲ(n= 177 strains),t 030(n= 177 strains),and typeⅠ(n= 196 strains)respectively.Conclusion The main epidemic clone of MRSA strain in this hospital is ST239-MRSA-SCCmec III-t030,antimicrobial resistance is serious,monitoring on drug-resistant strains in hospital should be strengthened.

Objective:To evaluate the effect of setup errors from daily cone-beam computed tomography (CBCT) on the accumulated dose under different image-guidance (IG) strategies, aiming to investigate the appropriate IG strategies during radiotherapy for the spine metastases.Methods:A total of 720 CBCT scans of 36 vertebral lesions were obtained. All 36 lesions were divided into the simultaneous boosting (PTV 40 Gy/20f, GTV 60 Gy/20f, n=20) and conventional radiotherapy groups (PTV 40 Gy/20f, n=16). The actual fractionated plan was recalculated simulatively after transferring the isocenter of the initial plan according to the interfraction setup error. Under no daily image-guidance (no-DIG) strategies including twice imaging guidance weekly (TIG), initial 5 days then weekly imaging guidance (5D+ WIG), WIG and no imaging guidance (NIG), the dose deviation was calculated between the delivered dose accumulated by each actual fractionated plan and the dose distribution under DIG. The tolerance of dose deviation for the target was within ±5% and the D max of the spinal cord was limited below 45 Gy. Results:Under different image-guidance strategies of TIG, 5D+ WIG, WIG and NIG, the median dose deviation was approximately ±1% for the CTV D 95% and D max of spinal cord. However, the median dose deviation was beyond -5% for the PTV D 95% when conventional radiotherapy was given. The median dose deviation was approximately 10% for the D max of spinal cord and the proportion of cases whose maximum irradiated dose of spinal cord was more than 4500 cGy was ≥70%. Also, the median dose deviation was beyond -5% for the GTV D 95% and PTV D 95% when simultaneous boosting was delivered. Conclusions:Because the dose deviation of CTV and spinal cord is within the tolerance limit, the image-guidance strategies could be chosen according to the clinical practice when conventional radiotherapy is delivered. However, the dose deviation of spinal cord, GTV and PTV exceeds the tolerance limit under no-DIG strategies when simultaneous boosting is delivered. Hence, it is necessary to perform daily IGRT for the spine metastases.

Lu Dangshen, a traditional authentic medicinal material of Codonopsis Radix is mainly produced in Shangdang (Changzhi) area of Shanxi Province. Baitiao Dangshen is mainly produced in Gansu Province. Codonopsis Radix contains many kinds of components such as phenylpropanoids, polyalkynes, alkaloids, terpenes, fatty acids, flavonoids, and so on. At present, the effect of producing areas on its chemical compositions has not been systematically studied. This study analyzed the differences of metabolites among Codonopsis pilosula from different producing areas by UPLC-HRMS. PCA, OPLS-DA coupled with Thermo mzcloud online and local databases were used to compare the overall differences of metabolites among Codonopsis pilosula from different producing areas, and the chemical constituents were identified to further screen and find out the different metabolites and analyze the metabolic pathways by information retrieval in HMDB, PubChem, Chemspider and KEGG databases. The results showed that 72 differential metabolites were identified in this study. There were 15 kinds of up-regulated and 57 kinds of down-regulated metabolites of Lu Dangshen compared with Baitiao Dangshen. The top 30 metabolic pathways were analyzed by KEGG enrichment, and the most important metabolic pathways were phenylpropanoid biosynthesis, which was demonstrated that phenylpropanoid biosynthesis pathway and related intermediate metabolites could be used as the characteristics of distinguishing Lu Dangshen from different habitats of Codonopsis pilosula. The present study provided a basis for analyzing the influence of producing areas on the chemical components of Codonopsis pilosula and reasonably evaluating the quality of Codonopsis Radix, and also provided a new idea for expounding the authenticity of Lu Dangshen.

Objective To explore the morphological changes of the brain structure in youngsters first-episode depression.Methods Collecting 1 6 youngsters patients with first-episode depression and 1 6 healthy volunteers,separately examining morphological changes in their brain regions by MRI,and then analyzing data by Voxel-Based Morphometry in order to observe the damaged brain areas in depression patients.Results Comparing with control group,gray mater volume of the left dorsolateral prefrontal cortex and right fusiform gyrus decreased in depression patients.The gray matter density of left dorsolateral prefrontal cortex showed negative correlation with HAMD scores.Conclusion The gray matter decreased in left dorsolateral prefrontal cortex and right fusiform gyrus in youngsters first-episode depression patients.In addition,the gray matter density of left dorsolateral prefrontal cortex had negative correlation with HAMD scores.