Objective To evaluate the clinical value of spectral CT mode in imaging liver by comparing the radiation dose and image quality between spectral CT and conventional multi-slice spiral CT (MSCT).Methods Thirty patients (group A) underwent three-phasic enhanced CT scans spectral CT mode in the portal phase (PP) and conventional helical mode in other phases (Discovery CT 750 HD,GE Healthcare).Another 30 patients in group B underwent conventional three-phasic enhanced CT on a 64-slice MSCT (VCT,GE Healthcare) with 120 kVp and automatic tube current modulation (ATCM) and noise index of 15.The images in PP from the two imaging modes were retrospectively compared.The contrast-noiseratio (CNR) for the veins was calculated using liver parenchyma as background.For the spectral CT mode,101 sets of monochromatic images were reconstructed from 40 to 140 keV,and the optimal energy level for obtaining the highest CNR was determined using the Gemstone Spectral Imaging (GSI)-viewer software.Image noise (at 70 keV),CNR (at the optimal keV level) for the vein and radiation dose to the patient were obtained for spectral images and statistically compared with those in group B with the conventional MSCT using t test.Results The CTDIw value in PP for spectral CT was 15.64 mGy,30％lower than the (22.44 ± 5.09) mGy for the conventional MSCT (t =29.56,P ＜ 0.01).Image noises on the liver parenchyma were 22.81 ±2.85 and 23.80 ±3.31 for the conventional MDCT and spectral CT images at 70 keV,respectively,with no significant difference (t =0.76,P ＞ 0.05).On the other hand,CNR for the vein at the optimal energy level in spectral CT was 7.17 ± 2.09,which was significantly higher than the 2.76 ± 1.34 for the conventional MSCT (t =7.21,P ＜ 0.01).Conclusion Compared with conventional standard-dose liver MSCT,spectral CT imaging provides improved CNR for vessels,comparable image noise for liver parenchyma with 30％ dose reduction.

Objective To understand and raise the level of osteopomsis-relied knowledge, attitudes and behaviors for prevention and treatment of osteoperosis(OP)in residents of a community. Methods A survey was performed with a questionnaires method targeting at the elderly residents in Changfeng community.The survey was conducted with a specifically designed questionnaire,followed by a second survey.during which health edueafion was stressed.Data were analyzed with SPSS 11.0 software. Results In 3524 residents.3367 responded positively.The ratio of male to female was 1:2.10.The average age of the respondents was 61.34 years.They demonstrated a low level of OP KAP.76.72% of them heard the term of OP,60.11% had a correct judgment of their own bone heahh,42.26% knew the cause of OP.and 37.75% understood the diagnostic method of OP.The level of OP KAP varied in different groups of targeted residents.Of all the questions.the understanding of the diagnosis ranked the lowest.2281 people participated in the second survey,which showed improvement in their OP KAP.The difference was statistically significant.1439 people auended the consultation.99.86% of them considered the activities necessary,96.92% expressed their satisfaction,and 98.54% planed tO take measures to improve their bone health.Conclusion The poor understanding of bone heaith status and the knowledge about prevention and treatment of OP is why it is widely spread in the modem society,which however Call be improved by education.

Objective To determine the treatment outcome and prognosis after resection of esophageal cancer.Methods 312 patients who developed recurrence after curative resection for squamous cell cancer of the thoracic esophagus were analyzed retrospectively.Results Recurrence was found after a mean period of 17.8 months(range 2～56 months).Recurrence pattern was catagorized into lymphatic,hematogerous,mixed and anastomotic.The number of patients in each recurrence group was 188,42,60,22.312 patients were enveloped into a noadjuant treatment group(NT,68),a radiotherapy alone group(RT,110),a chemotherapt group(CT,72) and a radiotherapy combined chemothepapy(CRT+CT,32).The 0.5-,1-,2-and 3-year overall survival rates for NT were 63.5%,35.2%,16.3% and 13.1%;For CT were 65.7%,52.3%,11.9% and 9.2%;For RT were 75.6%,49.2%,32.2% and 14.2%,respectively.Compared with CT there were significant differences in survival for patients receiving RT alone or combined with CT(P0.05).Multivariate analysis showed that depth of tumor invasion,lymph node metastasis,operative procedure and different regimens of therapy were significant prognostic factors.Conclusion Esophagectomy with cervical anastomasis is recommened for esophageal carcinoma,additional cervical lymphadenectomy is benefical in a few patients.Radiotherapy or combined with chemotherapy to be effective in prolonging the survival of patietns with recurrenes after esophageal resection for cancer.Investigation for more effective drugs and regimens of chemotherapy need to be taken.

Objective To investigate the value of echocardiography in the diagnosis of interrupted aortic arch (IAA). Methods Forty-three children that diagnosed as IAA by transthoracic echocardiography (TTE) were reviewed. The results of CTA (CT Angiography) and operation also were compared. Results Among the 43 children, 41 was admitted as IAA by operation and 2 were diagnosed as coarctation of aorta. According to the type of IAA, 25 cases were diagnosed as type A, 13 cases were diagnosed as type B, 3 cases were diagnosed as type C. Thirty-ifve cases were diagnosed by TTE correctly, 3 cases were misdiagnosed by TTE, 4 cases were suspected as IAA by TTE and ifnally conifrmed by operation. The accuracy rate was 81%(35/43). Among the 35 deifnite diagnosed cases, corrected typing cases were 30, the accuracy rate was 86%(30/35). The accuracy rate of type A, B, C were 96%(23/24), 64%(7/11) and 0. According to the results of CTA, 40 cases were diagnosed correctly, 1 case was misdiagnosed. The accuracy rate was 98%(40/41). Among the deifnite diagnosed cases, corrected typing rate was the same with operation result. Conclusions TTE is the ifrst choice for the detection of IAA. During TTE, in case the indistinct display of aortic arch, CTA should be used to improve the accuracy rate of IAA.

Objective To compare the value of color Doppler echocardiography in the diagnosis of coarctation of the aorta (COA) in comparison with CT angiography (CTA). Methods Ninety-two patients with COA were retrospectively analyzed that were confirmed by surgery from January 2009 to September 2013 and diagnosed by color Doppler echocardiography and CTA. Results Among 92 COA patients conifrmed by surgery, 87 patients were diagnosed correctly by echocardiography while 91 patients were diagnosed by CTA, and the accuracy of echocardiography and CTA were 95%(87/92) and 99%(91/92), respectively without significant difference (χ2=1.550, P=0.213). According to surgical findings, there were 222 anatomic abnormalities including 110 intra-cardiac, 13 heart-vessel connection and 99 vessel abnormalities. For 110 intra-cardiac abnormalities, echocardiography detected all abnormalities while CTA found 92 with 18 missed including 11 valve or valve ring lesions, 3 patent foramen ovale, 2 atrial septal defect, 1 ventricular septal defect and 1 endocardial cushion defect. The accuracy of echocardiography for intra-cardiac abnormalities was signiifcantly higher than that of CTA (100%, 110/110 vs 84%, 92/110,χ2=18.801, P=0.000). CTA and echocardiography detected all abnormalities of heart-vessel connection. For 99 vessel abnormalities, CTA showed an accuracy of 98%(97/99) with 2 missed lesions including 1 collateral circulation between the aorta and the pulmonary artery and 1 membranous narrow of the aorta, while echocardiography misdiagnosed 1 COA as interruption of aortic arch and missed 15 lesions, including 4 COA, 3 collateral arteries, 2 patent ductus arteriosus, 2 aberrant right subclavian artery, 2 brachiocephalic vein abnormality, 1 partial anomalous pulmonary venous drainage and 1 persistent left superior vena cava. The accuracy of CTA for detection of vessel abnormalities was signiifcantly higher than that of echocardiography (98%, 97/99 vs 84%, 83/99,χ2=11.350, P=0.000). Conclusions Both CTA and echocardiography are effective diagnostic modalities for COA and CTA is superior to echocardiography for detecting vessel anomalies whereas echocardiography is superior to CTA for detecting intra-cardiac abnormalities. The combination of both modalities will provide more accurate information for clinical diagnosis.

Objective To observe the effects of myriocin(ISP-1) on improvement of glomerular messangial cell(GMC) apoptosis and on gene expression profiles of cell cycle regulatory proteins in GMC.Methods Rat GMC was cultured with 100 ?mol/L ISP-1 for 6,12,24,and 48 h,apoptosis was evaluated through flow cytometry,Hoechst33258/PI fluorescence stainig and DNA fragmentation analysis was carried out under Sepharose electrophoresis to observe the changes of apoptosis and DNA fragmentation.Gene expression profiles of cell cycle regulatory proteins were detected by SuperArray Real-Time PCR microarray analysis.The expression of Bax and Bcl-2 proteins was investigated by Western blotting.Results ISP-1 could significantly induce GMC apoptosis in a time-dependent manner,which was the most significant after 48 h.Apoptosis bodys of GMC were observed by Hoechst/PI fluorescence staining,and a typical ladder pattern was identified in DNA electrophoresis.SuperArray Real-Time PCR microarray analysis revealed that ISP-1 could up-regulate the expression of genes involved in DNA damage,apoptosis and cell cycle regulation,such as Rad51,Atm,Brcal,caspases,cyclinA2,cyclinC,chek1,cyclinB1,cyclinB2,cyclinD2,cyclinF,Cdc25a,and P27.Western blotting showed that ISP-1 could significantly up-regulate Bax protein expression and down-regulate Bcl-2 protein expression,respectively.ConclusionISP-1 could induce GMC apoptosis in a time-dependent manner,propabably through influencing gene expression of cell cycle regulatory proteins and apoptosis proteins.

Objective To discuss the aged people N-terminal pro-B-type natriuretic peptide (NT-proBNP)changes in thyroid function disorder and its correlation.Methods With electrochemical luminescence analyzer,detected serum NT-proBNP lev-el 38 patients with hyperthyroid heart disease,68 patients with hyperthyroidism,31 patients with hypothyroidism,and 43 ca-ses of healthy controls.Compared each groupserum NT-proBNP level of older population with middle-aged people,and anal-ysied the correlation.Results The serum NT-proBNP level of Hyperthyroidism heart group,hyperthyroidism,hypothyroid-ism group and normal control group were 827.61±626.13,107.18±54.46,162.94±134.14,68.76±39.21 pg/ml,respec-tively.The serum level of HT-pro BNP.Hyperthyroidism group,hyperthyroidism,hypothyroidism group compared with nor-mal control group,there were statistically significan(t = 7.458,4.312,3.794,P = 0.000,0.000,0.001).Hyperthyroidism heart,hypothyroidism with hyperthyroidism group serum level of NT-proBNP comparison there was statistical significance(t=7.078,2.232;P = 0.000,0.032).Hyperthyroidism heartgroup,hypothyroidism group and normal control group older population was higher than the level of serum NT-proBNP middle-aged,difference was statistically significant (t=-3.216,-2.510,-2.653;P =0.007,0.016,0.014).Hyperthyroidism group of elderly serum NT-proBNP level higher than that of middle-aged people,but there was no statistically significant difference (t=-0.140,P =0.890).Multiple regression analy-sis in hyperthyroidism group serum levels of NT-proBNP and FT4 had positive correlation (r=0.224,P =0.033)and hypo-thyroidismgroup serum levels of NT-proBNP and T3 had negative correlation (r=-0.363,P =0.022).Conclusion Thy-roid dysfunction in elderly people for the level of serum NT-proBNP had significant influence.Auxiliary disgnosis and cura-tive effect observation of the serum level of NT-proBNP in people with different thyroid functional status has certain clinical value.

Objective To observe features of twist of the left ventricle (LV) in patients of essential hypertension (EH) with LV normal geometry (LVN) by three-dimensional speckle tracking imaging (3D-STI).Methods Thirty EH patients with LVN and 32 healthy control subjects were included.From the dynamic images of LV apical two-and four-chamber-views and three-dimensional full volume dataset acquired,the following parameters were obtained:peak of LV basal,middle and apical segment rotation (Prot-B,Prot-M and Prot-A),peak of LV global segment twist (LV-tw) and rotation (LV-rot),the global radial and longitudinal displacement (Dr,Dl) and the global 3D displacement (D3d).The difference of these parameters was compared between EH and control groups,and the correlation between LV-tw and the displacements in EH group was studied.Results Compared with the normal control group,Prot-B,Prot-M,Prot-A,LV-tw,LV-rot,Dr,Dl and D3d of EH group were significantly increased (P ＜ 0.01 or 0.05),and LV-tw showed significant correlation with Dr,Dl and D3d (P ＜0.01 or 0.05).Conclusions The evaluation of LV twist with 3DSTI in EH patients can reflect the changes of LV systolic function in early stage,3D-STI may provide a new modality for quantitative evaluation of early abnormality of LV function in clinical practice.

Objective The article was to analyze the payment structure of hospitalized urban employees receiving basic medi -cal insurance and the factors affecting the payment structure , resulting in measures to control the in-hospital fee of Medicare patients . Methods Statistical analysis was done on hospitalization expenses , expense composition and payment structure of hospitalized Medi-care patients in a first-class comprehensive hospital from 2002 to 2012 .The analysis of multiple stepwise regression were done on possi-ble influencing factors of hospitalization expenses and payment structure . Results With the adjustment of health policy , the propor-tion of medical insurance fund payment in the hospitalization expenses increased year by year , while the individual payment-scale re-duced accordingly .The hospitalization expenses and payment structure of Medicare patients were correlated with Medicare payment pol -icy, social demographic characteristics and clinical disease features . Conclusion By rational control on controllable factors , empha-sis on health care education , adjustment on Medicare payment policy and promotion on two way referral system , it is hopeful to realize the effective utilization of health resources , to achieve reasonable control on medical costs , and to reduce patients'economic burden .

ObjectiveTo evaluate the therapeutic efficacy and prognostic factors of intensity-modulated radiotherapy combined with chemotherapy for early-stage nasopharyngeal carcinoma patients in northwest China. MethodsFrom January 2006 to December 2009,58 patients with early-stage nasopharyngeal carcinoma were treated with IMRT in Xijing hospital,the clinical data were analyzed retrospectively.Survival rates was calculated by the Kaplan-Meier method and the differences was compared by the Logrank test.Univariate analysis method was use to identify all significant factors.ResultsThe follow-up rate was 100％.The follow-up time of 46 patients was more than 3 years.The 1-,2 and 3-year survival were 98％,94％ and 91％,respectively.The 3-year overall survival (OS),local recurrence-free survival (LRFS),distant metastasis-free surv ival (DMFS) for T1N0-1,T2N0 and T2N1 stage were 100％,100％,100％ and 74 ％,81％,87 ％,respectively ( x2 =5.74,P =0.01 ; x2 =4.95,P =0.03 ; x2 =4.24,P=0.04).The 3-year OS,LRFS,DMFS for IMRT combined with chemotherapy and IMRT alone were 100％,100％,100％ and 85％,85％,88％ respectively ( x2 =4.02,P =0.04; x2 =4.12,P =0.03 ; x2 =4.84,P =0.02).In T2N1 stage,IMRT combined with chemotherapy and IMRT alone were 100％,100％,100％ and 79％,79％,80％ respectively (x2 =5.28,P =0.03 ;x2 =4.84,P =0.04;x2 =4.72,P =0.04).In univariate analysis,N stage,clinical stage,IMRT combined with chemotherapy were significantly associated with the survival ( x2 =5.39,P =0.02 ; x2 =5.74,P =0.01 ; x2 =4.02,P =0.04).Conclusions In all early-stage nasopharyngeal carcinoma,T2N1 stage is a sub-group of high risk of distant metastasis.Combination of IMRT and chemotherapy may improve the LRFS,DMFS and OS in those patients.