Objective To investigate the effect of Ulinstatin(UTI) on oxygenation and gastric intramucosal pH in dogs with sepsis. Methods Sepsis was induced by intravenous infusion of lipopolysaccharide of E.coli.055:B5 to dogs,and the twenty dogs were divided into control group and ulinastatin group.Ulinastatin was administered in the ulinastatin group.The oxygen delivery(DO2),oxygen consumption(VO2), oxygen extraction(O2ER), plasma lactate levels and gastric intramucosal pH(pHi) were monitored. Results In early sepsis dogs,DO2,VO2,O2ER and plasma lactate levels increased significantly. Gastric intramucosal pH(pHi) decreased significantly. After the treatment with ulinastatin,DO2,VO2,O2ER and plasma lactate levels decreasd(P

Objective To evaluate the influence of the resolution of medical grayscale LCD over the detective efficiency of pulmonary nodule.Methods By reviewing PACS, 93 on-line chest DR images were collected.These radiographs included 23 normal images that had no nodule confirmed by CT, 32 doubtful images that also had no nodule confirmed by CT,and 38 positive images that had nodules confirmed by CT.These nodules didn't show obvious calcification and their diameters were from 0.30 to 1.90 cm. Nine patients had multi-nodules.Three residents or postgraduates, three attending physicians, and three associate professors or professors interpreted the 93 chest images by using three types of displays: Barco Z-2261, Barco Z-3620 and Barco Z-5620.All observers evaluated their confidence of the presence of pulmonary nodule with five-point level rating scale : ( 1 ) definitely positive, ( 2 ) probably positive, ( 3 ) uncertain, (4) probably negative, (5)definitely negative.SPSS 11.5 software was used to analyze the results ,including to draw the ROC curves and to perform Z test.Results The areas under the ROC curves of 2 M display, 3 M display and 5 M display were 0.774,0.784,0.816 for experienced radiologists; for instructors were 0.754,0.764,0.768 ;for teaching assistants were 0.695,0.754,0.774.However, for the detection of pulmonary nodules,there was no significant difference between observers with different ranks using the same modality of display,and no significant difference was found between the different modalities of displays used by observers with the same rank.Conclusion It's equivalent for detection performance with 2,3 and 5 M medical grayscale LCD display in detecting pulmonary nodule; Experienced radiologists can get more information using 5 M display;By reasonably matching displays, we could improve the cost-efficacy.

With the rapid development of society and the increasing improvement of living standard,people shows increasing demand for high quality of medical care so that more and more advanced medical instruments are applied to disease prevention,diagnosis and treatment.Thanks to the development of the professional medical technology,a new branch of medicine-clinical engineering has emerged.The history,current situation and future development of clinical engineering are mainly expounded.

With the rapid development of Picture Achieving and Communication System(PACS), the interpretation of medical images has been changing rapidly from a procedure based on films and light boxes to one based on computers and medical displays. The function parameters of Soft-Copy Reading carriers——medical grayscale display play an important part in radiodiagnosis because they can greatly influence the quality of medical image. It is very easy for quantitative assessment of this influence by using ROC curve theory, and it can direct hospital to select suitable medical display.

BACKGROUND: At present, extrusion is widely used in total knee arthroplasty. Studies have shown that extrusion can aggravate early pain and increase the risk of complications after operation. Therefore, a safer and more effective method it is urgently needed in clinic. OBJECTIVE: To observe the effects of elevation and extrusion of blood-expelling method on clinical outcomes during total knee arthroplasty. METHODS: Sixty-four patients who were scheduled to undergo unilateral total knee arthroplasty for the first time were randomly divided into two groups. During total knee arthroplasty, the control group received extrusion method, while the experimental group received elevation method. The main outcomes of the two groups were compared: Visual analogue scale score, knee joint swelling, C-reactive protein, serum creatine kinase activity and postoperative complications; secondary outcomes: Tourniquet use time, Hospital for Special Surgery score, and SF-36 score. RESULTS AND CONCLUSION: (1) Visual analogue scale scores in the experimental group were significantly lower than those in the control group on the first day, the seventh day, the first month and the third month after operation (P < 0.05). (2) Knee swelling, serum creatine kinase and C-reactive protein increased in both groups after operation, but the increase in experimental group was significantly lower than that in control group (P < 0.05). (3) In terms of postoperative complications, the incidences of tension vesicles and deep vein thrombosis in the control group were higher than those in the experimental group (P < 0.05). The total complication rate was significantly higher in the control group than in the experimental group (P < 0.05). (4) There was no significant difference in tourniquet use time between the two groups (P> 0.05). (5) Hospital for Special Surgery score and SF-36 score were assessed at 1, 3 and 6 months. The results showed that it was better than before, but there was no significant difference between the two groups (P > 0.05). (6) In conclusion, elevation of blood-expelling method could alleviate early pain response, reduce inflammation reaction and soft tissue injury, and decrease the incidence of skin tension blisters and thromboembolism. It is in line with the concept of rapid recovery. Therefore, during total knee arthroplasty, elevation of blood-expelling method is a safer and more effective method than extrusion.

Perfofinance of the radio-diagnostic system can be evaluated quantitatively by the analysis method of the ROC curve.Areas under the ROC curves represent the diagnostic perfogrmance efficiency.A comparison of the perforrmance variance of the diagnostic system incurred by different diagnosticians,will find the diagnostic competence of individual diagnosticians.This can help hospital management in deploying personnel in the department of radiology reasonably.

Objective: Evaluate the influence of monochrome LCDs with different resolutions for the quality of detail imaging and detection performance of lesions. Methods: 93 DR chest images were selected from PACS on-line, including 38 positive cases, 32 suspected cases and 23 normal cases. The positive cases were divided into two groups A and B according the diameter of pulmonary nodules. Three of high-, mid-and low-experienced radiologists interpreted the 93 images on three types of displays independently. Each observer marked their confidence of the presence of pulmonary nodule with five-point rating scale : (1)definitely absent, (2)probably absent, (3)possibly present, (4)probably present and (5)definitely present, and the visual quality of lung markings with three-point rating scale:(1) excellent, (2)free, (3) inferior. Software SPSS 13.0 was used to analyze the results. Results: For the detection performance of lesion, while detecting nodules of Group A, the areas under ROC curves were 0.643、0.686、0.739 on 2MP、3MP and 3MP display for high-experienced radiologist. Those were 0.636、0.682、0.717 for mid-experienced radiologist and 0.623、0.656、0.721 for low-experienced radiologist; while detecting nodules of Group B, those were 0.813、0.832、0.846 for high-experienced d radiologist, 0.773、0.824、0.838 for mid-experienced radiologist and 0.763、 0.7.73、0.833 for low-experienced radiologist. There were no significant differences among detection performance ofradiodiagnostic systems. For the quality of detail imaging, while interpreting the visualization of lung markings, the difference between high-and mid-experienced radiologist or between high-and low-experienced radiologist on 5MP display was conspicuous (P<0.05). But the differences of other comparisons did not reach the significant level. Conclusions: For the detection performance ofpulmouary nodules, it is comparable among different radiodiagnostic systems; for the visualization of lung markings, high-experienced radiologist could get more information on 5MP display.

Objective To assess the influence of medical monochrome liquid crystal displays (LCD) with different resolutions for the detection performance of micro-nodules (diameter <10 mm) on chest radiograms. Methods Eighty-seven DR chest images that were verified with CT were selected from PACS on-line, including 32 positive images, 32 suspected images and 23 normal images. The diameters of all nodules were lower than 10 mm. Three of high-, mid- and low-experienced radiologists who participated in the ROC study interpreted these 87 images using three types of LCDs with different resolutions, respectively. Regarding the presence of nodule, five-point confidence level rating scale was used, i.e. definitely absent, probably absent, possibly present, probably present and definitely present. All observers marked their confidence levels of every image according to the presence of pulmonary nodule on different displays. Software SPSS 13.0 was used for statistical analysis. Results AUC increased with the increasing resolutions and radiologists' experiences in 2MP, 3MP, 5MP displays. For the detection performance of pulmonary nodules (diameter <10 mm), there was no significant difference among different types of displays or different aptitudes of radiologists. Conclusion It's equivalent for the detection performance of pulmonary nodule (diameter <10 mm) on 2MP, 3MP and 5MP medical monochrome LCD when no restriction on the use of image post-processing tools. Highly-experienced radiologist can get the most information when using 5MP display. It is advisable to combine the diagnostic workstation system with high-, mid- and low-resolution monitors, and reasonable equipment scheme between different types of displays and different aptitudes of radiologists could result in better cost-efficacy.

Objective Evaluate the influence of medical monochrome liquid crystal display (LCD) with different resolutions on the detection of pulmonary nodules.Methods Ninety-three direct digital radiography (DR) chest images were selected on-line from picture archiving and communication system (PACS),including 38 positive,32 suspected and 23 normal cases.All of the images were confirmed by CT.These positive images were divided into group A and B according to the diameter of nodules.Three experienced radiologists blindly read the 93 images using three types of displays with different resolutions.Regarding the presence of nodule,five-point confidence system was used:definitely absent,probably absent,indefinite,probably present and definitely present.All observers marked their confidence levels of each image according to the presence of pulmonary nodule on different displays.Software SPSS 13.0 was employed for statistical analysis.Results In the group-A cases,the areas under ROC curves were 0.643,0.686 and 0.739,and in the group-B cases,those were 0.813,0.832 and 0.846 respectively.There was no difference in the detection efficacy among different radiodiagnostic systems.Conclusion Regardless of post-processing tools,it was equivalent to detect pulmonary nodules with different diameters of Group A or B among medical monochrome LCDs with different resolutions.

Objective To investigate the predictive value of preoperative serum tumor markers test for lymph node metastasis of intrahepatic cholangiocarcinoma (ICC).Methods The retrospecgtive cohort study was conducted.The clinicopathological data of 69 patients with ICC who were admitted to the Xinhua Hospital of Shanghai Jiaotong University between May 2006 and May 2016 were collected.Among 69 patients with pathological diagnosis,24 with lymph node metastasis were allocated into the lymph node metastasis group and 45 without lymph node metastasis were allocated into the non-lymph node metastasis group.Tumor markers of the 2 groups were preoperatively detected,including alpha-fetoprotein (AFP),carcinoembryonic antigen (CEA),prostate specific antigen (PSA),CA19-9,CA125,CA242,CA153,CA724,CA211,neuron-specific enolase (NSE) and squamous cell carcinoma antigen (SCC).Receiver operating characteristic (ROC) curve was built,and critical value,sensitivity and specificity were calculated based on ROC curve.Coincident rate between significant indicators and results of pathological examination was calculated.Observation indicators:(1) overall positive rates of tumor markers;(2) comparison of tmmor markers levels in the 2 groups;(3) tumor markers predicted ROC curve of lymph node metastasis and coincident rate between ROC curve and results of postoperative pathological examination.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (Q25,Q75) and comparison between groups was analyzed using the Wilcoxon rank sum test.Comparison of count data was analyzed by the chi-square test and Fisher exact probability.The statistically significant indicators were analyzed by the ROC curve.Results (1) Overall positive rates of tumor markers:positive rates of AFP,CEA,PSA,CA19-9,CA125,CA242,CA153,CA724,CA211,NSE and SCC in 69 patients were 27.5％ (19/69),29.0％ (20/69),4.3％ (3/69),69.6％ (48/69),36.2％ (25/69),50.7％ (35/69),26.1％ (18/69),21.7％ (15/69),62.3％ (43/69),31.9％(22/69) and 21.7％(15/69),respectively.Positive rates of AFP,CEA,CA19-9,CA125,CA242,CA153,CA724,CA211,NSE and SCC were more than 20％,which became comparison indicators of 2 groups.(2) Comparison of tumor markers levels in the 2 groups:levels of CA19-9,CA125,CA242 and CA211 were 284.9 U/mL (42.5 U/mL,730.3 U/mL),63.6 U/mL (23.4 U/mL,172.1 U/mL),71.7 U/mL (25.6 U/mL,138.9 U/mL),6.7 μg/L (3.9 μg/L,17.5 μg/L) in the lymph node metastasis group and 58.0 U/mL (25.9 U/mL,405.9 U/mL),18.2 U/mL (11.7 U/mL,33.8 U/mL),11.0 U/mL (3.7 U/mL,41.7 U/mL),3.7 μg/L (2.7 μg/L,6.9 μg/L) in the non-lymph node metastasis group,respectively,with statistically significant differences between the 2 groups (Z=2.016,3.213,3.143,2.482,P＜0.05).(3) Tumor markers predicted ROC curve of lymph node metastasis and coincident rate between ROC curve and results of postoperative pathological examination:area under the ROC curve of CA19-9,CA125,CA242 and CA211 were respectively 0.648 [95％ confidence interval (C I):0.515-0.781,P＜0.05],0.736 (95％ CI:0.608-0.864,P＜0.05),0.731 (95％ CI:0.603-0.859,P＜0.05),0.714 (95％ CI:0.581-0.847,P＜0.05).The positive critical value,sensitivity and specificity of CA19-9,CA125,CA242 and CA21 were 150.6 U/mL,35.7 U/mL,43.4 U/mL,6.0 μg/L and 62.5％,66.7％,70.8％,62.5％ and 71.1％,82.2％,77.8％,75.6％,respectively.The coincident rate between ROC curve and results of postoperative pathological examination of CA 19-9,CA 125,CA242 and CA211 were 68.1％ (47/69),76.8％(53/69),75.4％(52/69),71.0％(49/69),respectively.Conclusion The levels of serum CA19-9,CA125,CA242 and CA211 can effectively predict lymph node metastasis of patients with ICC.