Objective To investigate whether pulse pressure variation (△PP) reflect the effects of PEEP and fluid resuscitation (FR) on hemodynamic effects.Methods Twenty critical patients with acute lung injury was ventilated with volume control (VT =8 mL/kg,Ti/Te = 1: 2) ,and PaCO2 was kept at 35 to 45 mm Hg.PEEP was setted as 5 cm H2O and 15 cm H2O in randomized order.Hemodynamic parameters including cardiac index, pulse pressure, central venous pressure, etc.were monitered by PiCCO system.Measurements were performed after the application of 5 cm H2O PEEP (PEEPs group)and 15 cm H2O PEEP (PEEP15 group) respectively.When the PEEP-induced decrease in cardiac index (CI) was > 10%, measurements were also performed after fluid resuscitation.Results Compared with PEEPs group, CI was decreased significantly in PEEP15 group(P < 0.05), and APP was increased significantly (P < 0.05).In 14 patients whose PEEP-induced decrease in CI was > 10%, fluid resuscitation increased CI from (3.01±0.57)L · min-1· m-1to (3.62±0.68)L · min-1 · m-2(P<0.01),and decreased △PP from (17±3)% to (10±2) % (P < 0.01).PEEP15-induced decrease in CI was correlated negatively with APP on PEEP5 (r =-0.91,P < 0.01) and with the PEEP15-induced increase in △PP (r =-0.79, P < 0.01).FR-induced changes in CI correlated with APP before FR (r = 0.96, P < 0.01) and with the FR-induced decrease in APP (r =-0.95, P < 0.01).Conclusions In ventilated patients with ALI, △PP may be a simple and useful parameter in predicting and assessing the hemodynamic effects of PEEP and FR.

Objective To compare the lymph node dissection of left chest single incision and neck-right chest-abdomen incision in esophageal cancer surgery,and to explore the reasonable range of lymph node dissection in esophageal cancer surgery.Methods We retrospectively analyzed the clinical data of 72 patients with esophageal cancer radical surgery.According to the surgical approach,the patients were divided into left chest single-incision group (32 cases) and three-incision group (40 cases).The surgery time,number of lymph node resected,drainage tube time,length of hospital stay,lymph node dissection status and incidence of postoperative complications were analyzed.Results In left chest single-incision group and three-incision group,the operative time [(225.44 ± 11.98) min vs (265.42 + 13.15) min],lymph node dissection number[(8.031 ± 1.153) vs (11.821 ± 1.138)],length of stay [(13.212 ± 1.294) d vs(15.691 ± 1.404) d] and other aspects had statistically significant differences (t =24.201,25.302,14.010,all P ＜ 0.05).There were no significant differences between two groups in the chest tube indwelling time and the incidence of postoperative complications (P ＞ 0.05).Conclusion Both surgical radical resection of esophageal cancer have their own characteristics in terms of surgical difficulty,risks,efficacy and complications.In clinical,these must be carefully evaluated in patients with lesions and body affordability flexibility to choose the surgical approach in order to achieve the best therapeutic effect.

Objective To evaluate the medial longitudinal arch of the foot with and without hallux valgus in order to establish the relationship between hallux valgus and the arch. Methods 34 feet of 24 cases with hallux valgus and 34 normal feet of 18 cases were investigated by roentgenography. On the dorsal plantar view while weight-bearing standing, the hallux valgus angle (HVA), the first intermetatarsal angle, and the position of the tibial sesamoid relative to the first metatarsus were measured respectively. On the lateral view while weight-bearing standing, the top angle of the medial longitudinal arch, the anterior angle of the medial longitudinal arch (also named as the first metatarsal inclination angle) and the relative height of the talus, which are similar to measurement of the height of the medial longitudinal arch, were measured respectively. The characteristics of the medial longitudinal arch of the feet with and without hallux valgus were compared, and the correlation between the height of the medial longitudinal arch and the severity of the hallux valgus, which were manifested by the hallux valgus angle, first intermatatarsal angle, the relative position of the tibial sesamoid, was analyzed. Results The top angle of medial longitudinal arch was 136.9??7.6? in hallux valgus feet and 126.7??2.1? in normal feet; the anterior angle of medial longitudinal arch was 10.8??2.6? in hullux valgus feet and 16.6??1.6? in normal feet; the relative ratio of height of talus was 0.159?0.03 in hallux valgus feet and 0.199?0.01 in normal feet , there was significant difference between two groups. While with the increase of the lateral displacement of tibial sesamoid, the angle of hullxus valgus and the first intermetatarsal angle, the top angle of medial longitudinal arch became larger, the anterior angle of arch became smaller, and the relative height of talus became lower. The medial longitudinal arch of the foot with hallux valgus was collapsed, and there was moderate to high relationship between the height of the medial longitudinal arch and the severity of the hallux valgus. Conclusion Hallux valgus is a three dimensional deformity, which will disturb the normal biomechanics of the foot.

Objective To assess the practical value of ultrasound-guided percutaneous pericardium centesis in patients with pericardial effusion.Methods Twenty-eight patients with pericardial effusion were treated with ultrasound-guided percutaneous pericardium centesis from May 2004 to May 2009.Results Operations were successfully done in all 28 patients.The puncture needle,guide wire and drainage catheter could be clearly visualized under ultrasound.Complications included ache,bleeding and drainage catheter obstruction or prolapsus.Conclusion Able to be used bedside,ultrasoundguided percutaneous pericardium centesis is a real time,exact,safe and convenient method for the diagnosis and treatment of pericardial effusion.

3D medical image segmentation is a fundamental technique for computer assisted surgery and therapy. There exist various segmentation algorithms, but still we hope to have a more efficient and intuitive evaluation method for validation. In this paper, after reviewing the existing validation methods, we propose a new approach for 3D image segmentation validation. The details of the method are introduced in two parts: local error validation and global accuracy validation. Then, we apply it to validate three typical segmentation algorithms and a user proposed hybrid segmentation method in our experiment. The hybrid approach is also briefly introduced. The experimental results reveal that the proposed validation method can evaluate the employed segmentation methods more accurately and intuitionally.
Algorithms ; Diagnostic Imaging ; instrumentation ; methods ; Humans ; Image Enhancement ; methods ; Image Interpretation, Computer-Assisted ; methods ; Imaging, Three-Dimensional ; methods

Objectives:Dose-response effect of nicorandil cardioplegia at various concentrations was studied to optimize its myocardial protective effect.Methods:Forty-eight isolated working rat hearts were divided into 6 groups randomly.They were group A:control (depolarized cardiac arrest with St.Thomas solution No.2),group B,C,E,F and G:hyperpolarized cardiac arrest (nicorandil concentration were 25,50,100,125 and 150μmol/L respectively).The hearts underwent a 120-minute hypothermic arrest (15±1)℃ with cardioplegia (40 ml/kg) and reinfused with cardioplegia (40 ml/kg) at interval of 30 minutes.Mechanical arrest time,cardiac functional recoveries,myocardial content of malondialdehyde (MDA) and ultrastructure were measured.Results:The protective effect of nicorandil cardioplegia was dose-related.Conclusions:The optimal concentration of nicorandil in cardiplegia may be 100μmol/L for myocardial protection.

Objective To investigate the effect and mechanism of S100A16 in the course of 3T3-L1 preadipocytes differentiation.MethodsA recombinant virus vector overexpressing S100A16 ( PLJM1-S100A16-GFP) was constructed and transfected into 3T3-L1 preadipocytes.The expression of S100A16 in the course of 3T3-L1 preadipocytes differentiated into adipocytes was detected by Western blot.The lipid droplets were observed by oil-red O staining and triglycercide (TG) content was measured by the TG measure kit.Levels of adipogenesis-associated genes such as PPARγ,CCAAT/enhancer binding protein ( C/EBP-α),lipoprotein lipase ( LPL),fatty acid synthase ( FAS),adipocyte fatty acid binding protein( aP2 ) were measured by realtime PCR and Western blot.The interaction between S100A16 and p53 was detected by immunoprecipitation.Results3T3-L1 cell line overexpressing S100A16was successfully contructed.It was found that the expression of S100A16 was increased during 3T3-L1 adipocytes differentiation.Overexpression of S100A16 stimulated 3T3-L1 preadipocytes differentiation and increased the accumulation of triglycerides in adipocytes (P＜ 0.01 ),along with the up-regulation of adipocyte differentiationassociated gene expressions including PPARγ,C/EBP-α,LPL,aP2,and FAS ( P ＜ 0.05 or P ＜ 0.01 ).Immunoprecipitation analysis revealed that S100A16 interacted with tumor suppressor protein p53,also a known inhibitor of adipogenesis.ConclusionS100A16 stimulates 3T3-LI preadipocytes differentiation via inhibiting p53activity.

Purpose To investigate the influence of the region of interest (ROI) selection on the repeatability of 64 slice spiral CT perfusion parameters for the peripheral lung cancer.Materials and Methods The 64 slice spiral CT perfusion images of thirty-seven patients with peripheral lung cancer were retrospectively analyzed.The perfusion parameters including blood flow (BF),blood volume (BV),Patlak blood volume (PBV),permeability surface area product (PS),and mean transit time (MTT) were obtained by using three ROI selection methods including maximum area of ROI (ROIm),round of ROI (ROIr),and volume of ROI (ROLv),and these parameters were measured by two observers repeatedly.The repeatability and reliability of the values of these perfusion parameters by using different ROI methods or measured by different observer were determined.Results The perfusion parameters derived from three ROIs all had a excellent intraobserver and interobserver agreement (ICC＞0.75).Besides,the values of the perfusion parameters by using different ROI methods had no significant difference (P＞0.05),but the data obtained by ROIm and ROIv were more stable than that obtained by ROIr.Conclusion The repeatability of the perfusion parameters obtained from above three ROIs is excellent,but ROIm and ROIv may be more suitable than ROIr to assess vascular perfusion of peripheral lung cancer.

Objective To investigate the effects of ciprofloxacin on anastomotic stoma,small intestinal inflammation and fibrosis in interleukin-10 knock-out mice (mice model of Crohn′s disease (CD)) after ileocaecal resection.Methods Twelve interleukin-10 knockout male C3H/HeJBir mice were evenly divided into control group and ciprofloxacin group.The mice model was established with ileocaecal resection and ileocolostomy.There was no intervention in control group.Ciprofloxacin (50 mg/kg per day)was orally administrated in ciprofloxacin group for four weeks.All the mice were executed.The intestine around anastomotic stoma was taken for hematoxylin-eosin (HE)and Sirius red staining and histological scoring.The level of interferon (IFN)-γand tumor growth factor (TGF)-βin intestine around anastomotic stoma and small intestine was detected by enzyme-linked immunosorbent assay (ELISA) method.The content of procollagen α1 was determined by real-time polymerase chain reaction.The data were analyzed by t test.Results The inflammatory reaction level of anastomotic stoma and small intestine in mice of ciprofloxacin group (2.50±0.55 and 1 .67±0.52)was significantly lower than those of control group (3.67±0.63 and 2.83±0.75 ,t=-8.273,-5 .188,both P <0.05 ).The IFN-γof anastomotic stoma and small intestine also significantly decreased ((0.72 ±0.22 )pg/mg vs (1 .76 ±0.43 )pg/mg, (0.23±0.12)pg/mg vs (0.78 ± 0.52 )pg/mg;t = - 7.354,- 5 .268,both P < 0.05).However, ciprofloxacin could not significantly decrease fibrosis in anastomotic stoma and small intestine of CD mice. There was no significant difference in the level of TGF-βcompared with control group.Conclusions The role of ciprofloxacin in improving inflammatory reation in anastomotic stoma of CD mice was limited. Maintenance therapy may be necessary to reduce the relapse of anastomotic stoma diseases.

Objective To investigate the surgical management of Crohn's disease complicated with duodenal fistula.Methods The clinical data of 1 012 patients with Crohn's disease who were admitted to the Nanjing General Hospital of Nanjing Military Connnand from January 2002 to January 2014 were retrospectively analyzed.Of the 1 012 patients,22 were complicated with duodenal fistula,including 12 with ileocolonic anastomosis-duodenal fistula,7 with colo-duodenal fistula,2 with sigmoido-duodenal fistula and 1 with duodeno-enteric fistula.All patients received duodenal fistula repair + resection of diseased intestine.Patients were followed up via out-patient examination,phone call and email till May 2014.The condition of patients before and after enteral nutrition support was compared using the t test.Non-normal data were analyzed using the Mann-Whitney u test.Results Two patients with abdominal infection and 1 with gastrointestinal bleeding received emergent operation,and the other 19 patients received enteral nutrition support prior to operation.Three patients received emergent colostomy.Two patients had fistula at the duodenal anastomosis,and 1 patient was cured by enteral nutrition support + drainage for 12 days and the other 1 received reoperation.The energies provided by enteral nutrition and enteral + parenteral nutrition were (25.3 ± 2.1) cal/g and (28.5 ± 3.2) cal/g,respectively,and the time for nutrition support was (31 ± 5)days.The level of C-reaction protein and Crohn's disease activity index were decreased from 25 mg/L and 207 ± 111 before treatment to 2 mg/L and 117 ± 71 after treatment,with significant difference (u =53.000,t =0.942,P ＜ 0.05).The levels of body mass index,albumin and blood sedimentation rate were (17.0 ± 2.1) kg/m2,(35 ± 5) g/L and 26 mm/h before treatment,and (17.9 ± 2.8) kg/m2,(38 ± 5) g/L and 23 mm/h after treatment,with no significant differences (t =0.482,1.170,u =67.500,P ＞ 0.05).One patient was cured by enternal nutrition.Five patients received intestinal stoma and the other 13 patients received intestinal anastomosis.Twenty-two patients were followed up with the median time of 13.4 months (range,4.0-37.0 months).One patient had recurrence of ileocolonic anastomosis-duodenal fistula and received reoperation,and complications were not observed in the other 21 patients.Conclusions Selective operation is recommended for patients with Crohn's disease complicated with duodenal fistula.Enteral nutrition support is the first choice during the interoperative management.Resection of diseased intestine combined with repair of duodenal fistula after alleviation of Crohn's disease and malnutrition could achieve satisfactorv effect.