OBJECTIVE:To compare clinical efficacy,safety and economy of urokinase and alteplase each combined with Enoxaparin sodium in the treatment of acute ST segment elevation myocardial infarction (STEMI). METHODS:80 STEMI pa-tients were randomly divided into control group and observation group,with 40 cases in each group. Both groups received Aspirin enteric-coated tablet for antiplatelet aggregation,and Clopidogrel hydrogen sulfate tablet for anticoagulation before thrombolysis. Control group were given urokinase 1 500 000 U added into 0.9% Sodium chloride injection 100 ml,ivgtt,within 30 min;given Enoxaparin sodium injection 7 500 U intramuscularly 12 h after thrombolysis,for 3-5 d. Observation group was given Enoxaparin sodium 60 U/kg,ivgtt,1 mg/ml Alteplase for injection 8 ml with intravenous push,other 42 ml ivgtt within 90 min;continued to receive Enoxaparin sodium with 12 U/(kg·h)micro-pump for 48 h,followed by Low molecular weight heparin calcium injection 5 000 U intramuscularly,bid,for consecutive 5 d. Clinical efficacy of 2 groups were observed,and thrombolytic recanalization situa-tion were observed 30,60,90 and 120 min after thrombolysis. ECG,cost-effectiveness and ADR were also observed. RESULTS:The effective rate of observation group(92.50%)was significantly higher than that of control group(85.00%). The rates of throm-bolytic recanalization in observation group 60,90 and 120 min after thrombolysis were significantly higher than in control group, with statistical significance(P<0.05). Q wave time,Qwave/Rwave and ST segment deviation of observation group after treatment were significantly lower than those of control group,with statistical significance(P<0.05). The total hospitalization cost of obser-vation group was significantly higher than that of control group,with statistical significance(P<0.05);there was no statistical sig-nificance in effective rate and the per unit cost of thrombolytic recanalization rate (P>0.05). The incidence of ventricular aneu-rysm,pericardial effusion,heart failure or cardiac shock,angina pectoris after infarction,severe arrhythmia,death and other as-pects in observation group were significantly lower than in control group,with statistical significance(P<0.05). CONCLUSIONS:Alteplase and enoxaparin thrombolysis therapy is better than urokinase and enoxaparin for STMEI in respects of clinical efficacy, and thrombolytic recanalization with less ADR and better safety;urokinase is cheaper and better than alteplase in cost-effectiveness ratio. Both of them can be used after careful consideration.

Objective To investigate the effects of lower limb training combined with hyperbaric oxygen on motor function in a paretic lower limb and on the ability in the activities of daily living (ADL) of hemiplegic stroke survivors. Methods A total of 297 hemiplegic stroke patients received routine interventions and then were randomly divided into 3 groups. The hyperbaric oxygen group accepted hyperbaric oxygen, the training group accepted lower limb training, and the treatment group accepted both hyperbaric oxygen and lower limb training. Evalnations were carried out pretreatment and 30 d post treatment to assess the function of the paretic lower limb and ADL ability with the Fugl-Meyer assessment ( FMA), a modified Barthel index (MBI) , Berg's balance scale (BBS) and the timed up and go test (TUGT). Results FMA, MBI, BBS and TUGT scores in all 3 groups improved significantly compared with pretreatment. On the 30th day post treatment, the scores in the treatment group were significantly better than in the other two groups. Conclusions Lower limb training combined with hyperbaric oxygen can significantly improve motor function in the paretic lower limbs of stroke patients and their ADL performance.

Objective By using 18F-deoxyglucose (18F-FDG) positron emission computed tomography (PET-CT) to measure the brain glucose metabolism of patients with severe traumatic brain injury before and after hyperbaric oxygen (HBO) therapy,and to investigate the mechanisms of H BO treating patients with traumatic brain injury.Methods Twenty-six patients suffered form severe traumatic brain injury with stable vital signs within 2 weeks were randomly divided into the HBO group and the control group.The patients of both groups received routine clinical interventions (including neuroprotection,dehydration,reducing intracranial pressure,anti-infection and other symptomatic treatments).Patients of the HBO group received the basic treatment combined with HBO therapy one tine per day for 7 days per week.In early stage and 4 weeks after treatment,all patients were examined with PET-CT scanning and Glasgow coma scale (GCS),disability rating scale (DRS) at the same time.Results There was standard uptake value (SUV) of significant difference between affected and unaffected brain areas in two groups before treatment(P＜0.01),but no significant difference between two groups (P＞0.05).After 4-week of treatment,SUV of affected and unaffected brain areas of two groups improved,the damaged area of HBO group improved obviously and the SUV was much better than before treatment and the control group (P＜0.0l).The GCS and DRS scores of HBO group were also significantly better than that of control group (P＜0.05).Conclusion The 18F-FDG PET-CT examination showed that HBO therapy can significantly improve glucose metabolism function of the brain damaged area,promote the brain functional recovery and awakening,and improve the prognosis in patients with severe traumatic brain injury.

Objective To investigate the relationship between glucose excursion and cognitive function in aged type 2 diabetes. Methods A total of 248 aged type 2 diabetes were recruited in this study,all of them wore continuous glucose monitoring system (CGMS) for 3 d to evaluate the glucose excursion including mean amplitude of glycemic excursions (MAGE) which was used for assessing intra-day glycemia variability,and mean daily difference (MODD) which represented day-to-day glycemic variability.During the period of CGMS monitoring,all subjects accepted mini mental status examination (MMSE) for evaluating cognitive function.The relationships of MAGE and MODD with performance on cognitive tests were assessed. Results The over intra-day glucose excursion group had lower MMSE score than the narrow intra-day glucose excursion group[(24.25±6.75)vs.(25.97±0.47),P=0.025].The MMSE score was decreased in over day-to-day glucose excursion group compared with the narrow day-to-day glucose excursion group [(24.21 ± 6.47) vs. (26.01 ± 5.49),P =0.019]. A statistically significant association was observed between MAGE and the score of MMSE(r=- 0.308,P＜0.001),and between MODD and MMSE(r=-0.226,P =0.001).Conclusions Glucose excursion may affect cognitive function in aged type 2 diabetes.The over glucose excursion decreases the score of MMSE.

Objective To determine the relationship between visual signal intensity and quantitative signal intensity of HCC assessed with DWI and histopathological differentiation of HCC.Methods The MR examinations including MRI plain scan,LAVA dynamic enhanced scan and DWI (1.5T,b value:0 and 600 s/mm2) of 224 patients who had surgically resected HCCs were retrospectively reviewed.Histopathological examinations revealed that there were 31 well-,169 moderately-,and 24 poorly-differentiated HCCs.The incidence of each visually evaluated signal intensity and quantitative signal intensity of HCC assessed with DWI signal intensity and the relationship between signal intensity and histopathological differentiation were assessed for each sequence.Results (1) On DWI,56.7％ of HCCs appeared as obviously hyperintense,24.1％ tumors appeared as moderate hyperintense,and 19.2％ tumors appeared as isotense or slight hyperintense to the surrounding hepatic parenchyma.There was a significant difference between isotense/slight hyperintense and obvious hyperintense and histopathological differentiation (P ＜ 0.05).There was no significant difference between isotense/slight hyperintense and moderate hyperintense and histopathological differentiation (P ＜ 0.05).There was no significant difference between moderate hyperintense and obvious hyperintense and histopathological differentiation (P ＞ 0.05).Visually evaluated signal Intensity of HCC showed an inverse correlation with histopathological differentiation (r =-0.324,P ＜ 0.05).On DWI,the tumors tended to show a brighter signal with decreasing histopathological differentiation.(2) There was a significant difference in DWI signal intensity value among the well,moderately and poorly differentiated HCCs (P ＜ 0.05).The SI value of well differentiated HCCs was lower than that of moderately differentiated HCCs and poorly differentiated HCCs (P ＜ 0.05).The SI value of moderately differentiated HCCs was lower than that of poorly differentiated HCCs.However,there was no significant difference between the SI value of the moderately and poorly differentiated HCCs (P ＞ 0.05).ROC analysis showed that the optimal cutoff point of SI value in diagnosing well differentiated HCCs was 66.5.A cutoff SI value equal to or less than 66.5 was used to differentiate well-differentiated HCC from moderately-and poorly-differentiated HCC with a sensitivity of 90.1％ and a specificity of 71.9％.Conclusions On DWI,the tumors tended to show a brighter,visually evaluated signal intensity and higher quantitative signal intensity with decreasing histopathological differentiation (P ＜ 0.05).The quantitative signal intensity of HCC assessed with DWI signal intensity could only predict well differentiated HCC.It was limited in predicting histopathological differentiation of HCC using evaluating signal intensity and quantitative signal intensity of HCC assessed with DWI.

Objective To explore the effect on traditional experiment and case teaching method in regional anatomy study. Methods 80 students from 2014 medical students were randomly selected as the teaching subjects and divided into traditional group and case teaching group. The traditional group con-tained 40 students, using the traditional teaching method, while case teaching group had also 40 students with case teaching method. In the process of teaching, three clinical cases were introduced, including thesubtotal thyroidectomy thoracic outlet syndrome andpancreatic cancer. After the end of the course, the students conducted a unified questionnaire and examination. SPSS 18.0 was used for data line t test or chi square test between the two groups. Results The scores of the students in the case group in the selection questions, blanks and essay questions in the final exam were higher than those of the traditional group; The average total score of the case group was (85.69 ±11.61), while the traditional group was (73.19 ±18.66), and the difference was statistically significant (t=3.597, P=0.002). The results of the questionnaire showed that the students in the case group were higher than the traditional group, and the difference was statistically significant ( χ2=14.753, P=0.001). Conclusion The effect on regional anatomy study with case teaching method is better than the traditional teaching method, and it is a promising teaching reform for the med-ical students.

ObjectiveTo investigate its dynamic characteristics and pathological mechanism on magnatic resonance diffusion weighted imaging (DWI) after chemoembolization in rabbit liver VX-2 tumor model.MethodsForty New Zealand rabbits were included in the study and forty-seven rabbit VX-2 tumor models were raised by implanting directly and intrahepatically after abdominal cavity was opened.Forty VX-2 tumor models from them were divided into four groups.DWI was performed periodically and respectively for each group after chemoembolization.All VX-2 tumor samples of each group were studied by pathology.The distinction of VX-2 tumors on DWI was assessed by their apparent diffusion coefficient (ADC) values.The statistical significance between different time groups,different area groups,or different b-value groups was calculated using SPSS 12.0 software.ResultsWhen b-value was 100 s/mm2,ADC values in the area of VX-2 tumor periphery,VX-2 tumor central,or normal liver parenchyma around tumor became gradually low in sixteen hours after chemoembolization,and were the lowest at sixteenth hour,and then they increased gradually from sixteenth hour to fourty-eighth hour after chemoembolization.The distinction of ADC between different time groups was significant,respectively ( F =7.325,P ＜ 0.01 ; F =2.496,P ＜ 0.05 ; F =6.856,P ＜0.01 ).Cellular edema in the area of VX-2 tumor periphery or normal liver parenchyma around tumor increased quickly in sixteen hours after chemoembolization; however,from sixteenth hour to forty-eighth hour,cellular edema in the area of normal liver parenchyma around tumor decreased gradually and that in the area of VX-2 tumor periphery decreased lightly at first and then increased continually.Cellular necrosis in the area of VX-2 tumor periphery after chemoembolization was more significant than that before chemoembolization.The areas of dead cells in VX-2 tumors manifested low signal and high ADC value while the areas of viable cells manifested high signal and low ADC value.ConclusionsDWI is able to detect and discriminate tumor necrotic areas from viable cellular areas before and after chemoembolization.ADC of normal liver parenchyma and VX-2 tumor are influenced by intracellular edema,tissue cellular death,and microcirculation disturbance after chemoembolization.

Objective To investigate dynamically characteristics of apparent diffusion coefficient (ADC) of MR diffusion-weighted imaging (DWI) in the rabbit VX-2 tumor model.Methods Forty New Zealand rabbits were included in the study and forty-seven rabbit VX-2 tumor models were raised by implanting directly and intrahepatically after abdominal cavity was opened.DWI was carried out periodically and respectively on seventh,fourteenth,and twenty-first day after implantation.Part samples of VX-2 tumors were studied by pathology.The distinction of VX-2 tumors on DWI was assessed by their ADC values.The statistical significance between different time groups,different area groups,or different b-value groups was calculated using SPSS12.0 software,respectively.Results ADC values of 47 VX-2 tumors in the area of tumor periphery,tumor center,and normal parenchyma around tumor were greater when b-value was 100 s/mm2 than those when b-value was 300 s/mm2 and the distinction of VX-2 tumor ADC in the area of tumor periphery,tumor center,and normal parenchyma around tumor between different b-value groups was significant,respectively( F =17.964,P ＜0.01 ; F =13.986,P ＜0.01 ; F =128.681,P ＜0.01 ).The ADC values in the area of normal liver parenchyma around tumor were greater than those in the area of VX-2 tumor periphery and tumor center when the b-value was 100 or 300 s/mm2.When b-value was the same( 100 or 300 s/mm2),the distinction of VX-2 tumor ADC between different areas was significant( F =176.586,P ＜0.01 ; F =55.089,P ＜0.01 ).The ADC of VX-2 tumor in the area of tumor periphery and tumor center became gradually low from seventh to fourteenth or twenty-first day after implantation and the distinction of ADC between different time groups but the area same (?) was significant( b =100 s/mm2,F =48.211,P ＜0.01 ;b =300 s/mm2,F =20.955,P ＜0.01 ).There were not obvious cellular necrosis in VX-2 tumors on seventh and fourteenth day after implantation but ADC of VX-2 tumor decreased unobviously because of cellular edemata in or around tumors.There were obvious cellular necrotic areas in VX-2 tumors on the twenty-first day after implantation.ADC of viable tumor cells in VX-2 tumors were lower on DWI than that in the area of normal liver parenchyma around tumor and ADC of dead tumor cells in VX-2 tumors were unequal,including high values,equal values,and low values but they were higher than that in the area of normal liver parenchyma around tumor after dead tumor cells had been liquified or had become cystic.Conclusions ADC is able to reflect objectively the diffusion of water molecules in the tumor and to reflect indirectly the degree of the growth and liquified necrosis of a tumor.ADC has an important and potential value in monitoring dynamical tumor growth and in evaluating malignant degree and therapeutic effect.

【Objective】 To analyze the effects of IgG subtypes(IgG 1 and IgG3) of antibodies contained in infant serum and erythrocyte eluates on hemolytic disease of the newborn(HDN), so as to provide reference for its early clinical diagnosis and treatment. 【Methods】 49 newborns with HDN in our hospital from June 2019 to March 2020 were detected for three hemolytic tests(direct antiglobulin test, elution test and indirect antiglobulin test), as well as the components of IgG1 and IgG3 in eluates. The correlation analysis was conducted by combining birth hours (physiological jaundice) and hemolytic degrees (total bilirubin, indirect bilirubin, and hemoglobin). 【Results】 In the 44 cases of IgG1 and IgG3 subtype detection of infant RBC eluates, regression equations could be established between total bilirubin, indirect bilirubin and birth hours, and between hemoglobin and elution test, and linear regression relationships were found (P<0.05). In the 28 cases of IgG1 and IgG3 subtype detection of infant serum, regression equations could be established between total bilirubin, indirect bilirubin, birth time and IgG3 subtype, and between hemoglobin and IgG1 subtype (P<0.05), and linear regression relationships were found (all P<0.05). Three infants, presenting IgG1 and IgG2 subtypes(+ ) and three hemolysis tests(-), were all second pregnancy, constituted by Rh-HDN of 2 case and other-system-HDN 1. 【Conclusion】 The degree of HDN is directly related to IgG1 and IgG3 antibodies in infant blood plasma. In addition to the total bilirubin and indirect bilirubin, the changes of IgG3 antibodies in infant plasma and IgG1 antibody in anemic infants should be monitored. If IgG1 and IgG3 antibodies are yielded even with all negative ABO-HDN hemolysis tests, non-ABO-HDN should be considered in time to achieve accurate diagnosis and treatment.

ObjectiveTo investigate the value of magnetic resonance imaging-proton density fat fraction （MRI-PDFF） in evaluating hepatic steatosis in patients with chronic hepatitis B virus （HBV） infection. MethodsThe patients， aged >16 years， who visited the outpatient service or were hospitalized in Beijing Tsinghua Changgung Hospital from January 2018 to December 2022 and were diagnosed with chronic HBV infection were enrolled， and all patients underwent MRI examination of the liver in our hospital. The patients were divided into groups based on the presence or absence of liver cirrhosis， and the consistency in PDFF between different hepatic segments was compared between groups. The Kappa consistency test and intraclass correlation coefficient （ICC） were used for consistency analysis. ResultsA total of 76 patients treated with nucleoside analogues were enrolled， among whom 23 （30.26%） had liver cirrhosis. For all patients， the simple arithmetic average of PDFF fluctuated between 1.49% and 30.93%. According to MRI-PDFF ≥5% as the diagnostic criterion for fatty liver disease， there were 29 patients （38.16%） with fatty liver disease among all patients. For all 76 patients， the simple arithmetic average of PDFF was lower than the weighted average of PDFF for the whole liver， and there was no significant difference between the simple arithmetic average of PDFF， the weighted average of PDFF， and the PDFF values of the left and right lobes of the liver （F=0.39， P=0.76）. The consistency test showed that the PDFF values of each hepatic segment and the left and right lobes of the liver had strong consistency with the weighted average and simple arithmetic average of PDFF， with an ICC of >0.75， but the consistency between the PDFF value of the right lobe and the weighted average of PDFF was higher than that between the PDFF value of the left lobe and the weighted average of PDFF. In the consistency test of differentiating fatty liver disease in patients with liver cirrhosis， there was poor consistency between the PDFF value of segment Ⅶ and the weighted average of PDFF （Kappa=0.39）， with moderate consistency for the left lobe and the Ⅰ， Ⅱ， Ⅲ， Ⅴ， Ⅵ， and Ⅷ segments. For the patients with liver cirrhosis， the lowest consistency was observed between the PDFF value of Ⅶ segment and the weighted average of PDFF for the whole liver， and the highest consistency was observed between the PDFF value of Ⅵ segment and the weighted average of PDFF for the whole liver. For the patients without liver cirrhosis， the lowest consistency was observed between the PDFF value of Ⅱ segment and the weighted average of PDFF for the whole liver， and the highest consistency was observed between the PDFF value of Ⅴ segment and the weighted average of PDFF for the whole liver. ConclusionMRI-PDFF is more comprehensive in evaluating hepatic steatosis in patients with chronic HBV infection， and for the patients with liver cirrhosis， there is poor consistency between the PDFF value of each segment and the weighted average of PDFF.