Objective To evaluate the value of MR imaging with a contrast enhanced multi phasic isotropic volumetric interpolated breath hold examination (VIBE) in diagnosis of primary liver carcinoma. Methods Thirty two consecutive patients with surgical pathologically confirmed 42 foci of primary carcinoma of liver underwent comprehensive MR examination of the upper abdomen, routine two dimensional (2D) T1WI and T2WI images were acquired before administration of Gd DTPA for contrast enhancement. Then, contrast enhanced multi phasic VIBE was acquired followed by 2D T1WI images. The lesion appearances on hepatic arterial, portal venous and equilibrium phases of VIBE sequence were carefully observed along with delineation of hepatic arterial and portal venous structures. The lesion detection rates and lesion characterization ability were compared among various MR sequences. Results 33(78.6%), 30(71.4%), 38(90.5%) and 42(100%) foci were displayed respectively on T2WI, non enhanced T1WI, enhanced T1WI and enhanced 3D VIBE images ( P

Objective This study on a medium-fidelity simulator (SimMan , Laerdal Medical Corpo-ration,Wappingers Falls, NY, USA) examined the management of unanticipated difficult airway by residents of anesthesiology and the effect of training in this context.Methods 30 residents of anesthesiology were devided into two groups (T and E). There were two scenarios investigated:'can't intubate, can oxygenate'(CI) and'can't intubate, can't oxygenate'(CICO). The E group was trained by scene simulation in the second, fourth, sixth month respectively before and after the training, and the T group received the same situation simulation training on the same day after the theoretical training and in the second, sixth month after the training. In con-trast to standard operating procedures, the performance of two groups of trainees was recorded on the basis of pre established evaluation criteria. Data differences between the two groups were analyzed using SPSS 23.0,t test, M-W test andx2 test.ResultIn CI, success rate of placement of astandard and intubating laryngeal mask air-way were high in T group (87％ vs. 55％ ,P=0.037). This was sustained over time. There was no difference in duration and incidence of desaturation between two groups. In CICO, there was a more structured approach following training in T group (P<0.05), which wasn't sustained over time. But this was sustained over 6 months in E group.ConclusionSituational simulation training can significantly improve the anesthesiology residents' ability to take proper response measures to the unexpected difficult airway, and significantly shorten the training time for emergency airway treatment. Repeated situational simulation training should be conducted at intervals of 2 months or less, allowing residents to maintain emergency response to the emergency airway.

OBJECTIVE To study the isolation rate of Acinetobacter baumannii, characteristics of infection distribution and antimicrobial resistance rates. METHODS Surveillance data of A. baumannii infection of wards, its distribution and resistance rates to 20 kinds of antibiotics in our hospital for 5 years were analyzed . RESULTS During the 5-year infection surveillance, 523 strains of A. baumannii were isolated in our hospital mostly from sputum. The commonest site was lower respiratory tract. The ward with the highest incidence of A. baumannii infection was ICU. The isolation rate was 11.1% in 2004, though 3.9% in 2000. A. baumannii was resistant to 20 kinds of antibiotics, especially to imipenem, cefoperazone /sulbactam and ampicillin/sulbactam. CONCLUSIONS The isolation rate of A. baumannii and antimicrobial resistance rate are increasing year by year. The increased rate of multidrug-resistance should be payed more attention .

AIM: To explore the influence of different concentration midazolam on the macroscopic voltage gated potassium currents and to discuss the relationship between potassium currents and inhibitory effect of clinical relevant concentration midazolam on sympathetic nervous system. METHODS: Superior sympathetic ganglion neurons were dissociated enzymatically from 7 to10 day old rat. Experiments were performed about 5 h after plating at room temperature (20- 24 ℃ ). Appropriate solution was chosen to separate the K + current from the other transmembrane currents. 1 ?mol?L -1 TTX was applied to the extracelluar solution to block the Na + current. Midazolam was also resolved in extracelluar solution to get various concentration ( 0.1 , 0.3 ,3,10,50,100 ?mol?L -1 ). Currents were recorded with the patch clamp technique in whole cell configuration using glass electrodes with a tip resistance of 2- 4 M . Potassium currents were evoked by test pulse from -100 mV to +30 mV with holding potential -80mV. Data were analyzed using Clampfit 6.0 and Oringih 5.0 software. Whole cell current records were corrected for leakage and capacitance by using the P/5 protocol. RESULTS: Midazolam dose dependently inhibited the whole cell potassium currents. Clinical relevant concentration midazolam ( 0.3 ?mol?L -1 ) only reduced the peak currents by 3.89 %(P= 0.88 ). The concentration required to produce 50% current inhibition(IC 50 ) was 76.065 ?mol?L -1 . CONCLUSION: Midazolam inhibits the whole cell potassium current significantly and dose dependently, but clinical relevant concentration midazolam has minor effect on the potassium currents, indicating that the inhibitory effect of midazolam on potassium current is not related to the suppression of activity of sympathetic system.

Objective To compare the serum levels of transforming growth factor (TGF)-beta 1,bone morphogenetic protein (BMP)-4 in patients with rheumatoid arthritis (RA) and RA with interstitial lung disease (RA-ILD).Methods Twenty-eight RA-ILD patients,32 patients with RA but without ILD and 20 normal controls were enrolled.The RA-ILD group was further divided into early group and late group.All the observed subjects were analyzed using enzyme linked immunosorbent assay (ELISA) for the determination of serum TGF-β1 and BMP-4 levels.The relationship between the serum levels of TGF-β1,BMP-4 and laboratory examinations were investigated.Comparisions between groups were tested by one-way ANOVA analysis and ttest.Correlation of indexs were observed by Spearman method.Results Patients in the RA-ILD group were older than RA group in disease onset age,in addition,patients with ILD had better joint function and higher serum rheumatoid factor titers.The occurrence time of interstitial lung disease was 2-6 years after the onset of arthritis,with an average time of (3.0±1.2) years.The TGF-β1 levels in the RA-ILD group were slightly higher,but not statistically significant than other groups (P＞0.05).The TGF-β1 serum levels in the early RA-ILD patients were significantly increased than those of the late RA-ILD group and the RA group.BMP-4 levels in patients with RA-ILD group were less than RA without ILD group and healthy control group,and the difference was statistically significant (P＜0.05).BMP-4 level in early RA-ILD group was significantly decreased than those of the late RA-ILD group and RA group.No correlation between the serum BMP-4,TGF-β1 level (P＞0.05) no assay result correlated with laboratory parameters including ESR,CRP,RF and anti-CCP antibodies (P＞0.05).Conclusion TGF-β1 serum levels are increased and BMP-4 levels are decreased in early RA-ILD patients.The serum levels of TGF-β1 and BMP-4 may be indicatior for asymptomatic ILD and reflect disease progression.

Objective To investigate the morphological features of normal lumbar dorsal root ganglia using a three-dimensional(3D)coronal MR imaging.Methods One hundred and fifteen volunteers were included.Ages ranged from 15 to 75 years,with a mean of 40 years.Coronal 3D fast field echo(FFE) with water selective excitation(Proset)MR examination of 1150 dorsal root gangha were underwent at nerve root levels from L1 to L5.The source coronal images were further reconstructed into a series of rotational alignment coronal images with an interval angel of 12 degree using maximum intensity projection(MIP) technique.All DRGs of bilateral spinal nerve from L1 to L5 were morphologically analyzed on the original and MIP images including qualitative evaluation of the location,signal intensity,architecture and quantitative dimensional measurement.Results There were 225,225,219,210 and 160 foraminal ganglia from L1 to L5 level,respectively.The incidence of intraspinal ganglia from L3 to L5 gradually increased with a maximum at L5 level of 29.1%(X~2=188.371,P

Objective To determine the impact of fluorine and aluminum,and both action combined on the number of rat osteoclasts and bone resorption cultured in vitro and to explore its mechanisms.Methods The osteoclasts and bone marrow stromal cells (BMSCs) isolated from long bone of new born rats were cultured,respectively,in TC199 medium (containing 10％ fetal bovine serum) with fluoride,aluminum and fluoride combined with aluminum.The osteoclasts were inoculated in 96-well culture plate and ivory slice,BMSCs in 6-well culture plate,and culture medium was changed after 2 hours incubation.The cells were divided into control group,fluoride group,aluminum group and fluoride combined with aluminum group; the doses of sodium fluoride were 0,1.0 × 10-4,0,1.0 × 10-4 mol/L and the doses of aluminum chloride were 0,0,1.0 × 10-5,1.0 × 10-5 mol/L,respectively.Tartrate-resistant acid phosphatase (TRAP) staining positive cells were counted under light microscope after TRAP staining on the 5th day and the pit formed in ivory slices were measured by histomorphometry after staining with toludine blue.The expression of osteoprotegerin(OPG) and receptor activator of nuclear factor kappa-B ligand (RANKL) was detected by real-time fluorescence quantitative PCR in BMSCs after 8 h treatment.Results ① Fluoride,aluminum and the interactive effects of fluoride and aluminum all had impact on the numbers of osteoclasts (F =7.15,6.56 and 7.98,respectively,all P ＜ 0.05).The numbers of osteoclasts in fluoride group,aluminum group and fluoride combined with aluminum group[(136.9 ± 22.99),(135.4 ± 23.5),(163.0 ± 24.4) per well] were higher than that in the control group[(92.5 ± 22.1) per well,all P ＜ 0.05].② Fluoride,aluminum and the interactive effects of fluoride and aluminum all had impact on the resorption pit area on ivory slices(F =10.47,12.64,14.29,respectively,all P ＜ 0.05).The resorption pit area on ivory slices in fluoride group,aluminum group and fluoride combined with aluminum group[(0.242 ± 0.031),(0.293 ± 0.026),(0.333 ± 0.016)mm2 per slice] was higher than that in the control group [(0.088 ± 0.030)mm2 per slice,all P ＜ 0.05].③Fluoride,aluminum and the interactive effects of fluoride and aluminum all had impact on the expression ratios of RANKL/OPG in BMSCs (F =8.15,15.38,23.59,respectively,all P ＜ 0.05).The expression ratios of RANKL/OPG in BMSCs in fluoride group,aluminum group and fluoride combined with aluminum group [(193.98 ± 137.93)％,(326.11 ± 176.78)％,(599.84 ± 275.82)％] were higher than that in the control group[(100.00 ± 56.02)％,all P ＜ 0.05].Conclusions Both fluoride and aluminum can cause increase in the number of osteoclasts in vitro and promote cell differentiation and bone resorption activity,which may be related to increased expression ratio of RANKL/OPG mRNA in BMSCs.The stimulating effects of fluoride on osteoclasts differentiation and bone resorption is enhanced by aluminum.

Objective To determine the effects of fluoride on osteoclasts's quantity and bone resorption function in vitro and its mechanisms. Methods The osteoclasts and bone marrow stromal cells(BMSCs) isolated from long bone of new born rats were cultured respectively in TC199 medium (containing 10% fetal bovine serum) with fluoride. The osteoclasts were inoculated in 96-well culture plate and ivory slice, BMSCs were inoculated in 6- well culture plate, respectively, medium were changed after 2 hours incubation. They were divided into control group, low-dose fluoride, medium-dose fluoride and high-dose fluoride groups, the doses of sodium fluoride were 0,2.5 × 10-5,5.0 × 10-5,10.0 × 10-5 mol/L, respectively. Tartrate-resistant acid phosphatase(TRAP) staining positive cells were counted under light microscope after TRAP staining on the 2nd and the 5th day and the pit formed in ivory slices were measured by histomorphometry after staining with toludine blue. The expression of receptor activator of NK-κβ ligand(RANKL) and osteoprotegerin(OPC) was detected by real-time fluorescence quantitative (337.5 ± 70.5), (447.5 ± 43.4), (472.9 ± 34.8), (475.3 ± 24.3)/well in the control group, the low-dose, mediumdose and high-dose fluoride groups, respectively. The differences were statistically significant between these groups and the control group (all P < 0.05). After in vitro culture for 5 days, the numbers of osteoclasts were (92.5 ± 22.1), (123.0 ± 26.4), (135.5 ± 22.2), (136.9 ± 23.0) per well in the control group, the low-dose, medium-dose and high-dose fluoride groups, respectively. The differences were statistically significant between these groups and the (0.088 ± 0.030), (0.100 ± 0.018), (0.152 ± 0.015), (0.242 ± 0.031 )mm2 per piece in the control group, the lowdose, medium-dose and high-dose fluoride groups, respectively. The values of medium-dose and high-dose fluoride BMSCs in the control group, the low-dose, medium-dose and high-dose fluoride groups were 100.00 ± 56.02, 144.95 ± 97.21,223.25 ± 184.48,193.98 ± 137.93, respectively. The values of medium-dose and high-dose fluoride groups were significantly higher than that of control group (all P < 0.05). Conclusions Fluoride can cause increase in the number of osteoclasts in vitro and promote their cell differentiation and bone resorption activity, which may be related to increased expression ratio of RANKL/OPG mRNA in BMSCs.

Objective To explore the clinical efficacy of laparoscopic transabdominal preperitoneal (TAPP) hernia repair and risk factors affecting postoperative complications.Methods The retrospective casecontrol study was conducted.The clinical data of 595 patients who received laparoscopic TAPP hernia repair in the First Affiliated Hospital of Soochow University from February 2008 to August 2016 was collected.Operations were performed by the same doctors' team.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) follow-up situations;(4) risk factors affecting complications after laparoscopic TAPP hernia repair.Follow-up using outpatient examination and telephone interview was performed to detect the recovery time of non-restricted activity,postoperative complications and hernia recurrence up to February 2017.Measurement data with normal distribution were represented as (x)±s.The univariate analysis and multivariate analysis were done using the chi-square test and Logistic regression model.Results (1) Surgical situations:595 patients underwent laparoscopic TAPP hernia repair using the heavy meshes.Overall operation time and overall volume of blood loss were (55±25) minutes and (7±5)mL,including operation time of (50±20)minutes in 502 unilateral hernias and operation time of (81 ± 29)minutes in 93 bilateral hernias.Of 595 patients,34 had incarcerated hernia,the contents of hernia:greater omentum,small intestine and sigmoid colon were detected in 21,11 and 2 patients,respectively,with an incarcerated time of 2-21 hours;4 with incarcerated hernia induced small intestinal necrosis received laparoscopy-assisted small intestinal resection ± anastomosis,1 with sigmoid colon necrosis received necrotic sigmoid canal resection ± sigmoidostomy and 29 received repair after the contents restoration of hernia.Operation time and volume of intraoperative blood loss in 34 patients with incarcerated hernia were (84 ± 39)minutes and (12±6) mL.Thirteen of 595 patients (10 with indirect hernia and 3 with direct hernia) had recurrent hernia,and operation time and volume of intraoperative blood loss were (75±-26)minutes and (10± 5)mL.(2) Postoperative situations:time to initial exsufflation of 595 patients was (19± 12)hours.Of 595 patients,590 took fluid diet at 6 hours postoperatively and 5 undergoing enterectomy took fluid diet at 24 hours postoperatively.The pain score at 1 day postoperatively and duration of hospital stay were respectively 2.5± 1.4 and (2.1± 1.9)days.(3) Follow-up situations:of 595 patients,593 recovered non-restricted activity at 2 weeks postoperatively and 2 didn't recover non-restricted activity at 2 weeks postoperatively.Of 595 patients,542 were followed up for 6-60 months,with a median time of 31 months.Fifty-seven,25,13 and 1 patients were respectively complicated with seroma,surgical pain,urinary retention and enteroparalysis,they were improved by symptomatic treatment,and the same patient can have multiple complications.There were no severe complications which needed surgical intervention,such as vascular injury,damnify of intestinal canal and poke hole hernia.Of 2 patients with recurrence of hernia,1 with right indirect hernia had recurrence of direct hernia and then received Lichtenstein tension-free hernia repair,and 1 received treatment in other hospital.(4) Risk factors affecting complications after laparoscopic TAPP hernia repair:results of univariate analysis showed that age,diameter of hernia sac,incarcerated hernia,recurrent hernia,operation time and volume of intraoperative blood loss were related factors affecting complications after laparoscopic TAPP hernia repair (x2 =6.657,55.296,44.305,5.253,117.461,100.722,P＜0.05).Results of multivariate analysis showed that diameter of hernia sac ≥ 4 cm,incarcerated hernia,operation time ≥ 100 minutes and volume of intraoperative blood loss ≥ 10 mL were independent risk factors affecting complications after laparoscopic TAPP hernia repair (OR =3.610,11.315,12.401,7.346,95％ confidence interval:2.009-6.486,3.579-35.772,5.408-28.437,3.739-14.434,P＜ 0.05).Conclusion Laparoscopic TAPP approach for inguinal hernia is safe and effective,and diameter of hernia sac ≥4 cm,incarcerated hernia,operation time ≥ 100 minutes and volume of intraoperative blood loss ≥ 10 mL are independent risk factors affecting complications after laparoscopic TAPP hernia repair.

Objective:To investigate the effects of rosuvastatin and lfuvastatin on patients with acute coronary syndrome (ACS) combing impaired glucose tolerance (IGT).
Methods: A total of 215 consecutive ACS patients combing IGT treated in our hospital from 2009-05 to 2011-05 were studied. The patients were randomly divided into 2 groups, Rosuvastatin group, the patients received rosuvastatin10mg/day, n=108 and Fluvastatin group, the patients received fluvastatin 40mg/day, n=107. The total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) levels before and at 6, 12, 24 months after medication, fasting blood glucose (FBG), 2-hour postprandial glucose (2hPBG) and the number of new-onset of diabetes patients were compared between 2 groups.
Results: After treatment, the TC, LDL-C levels were decreased (6, 12, 24 months) and the HDL-C level (12, 24 months), 2hPBG (24 months) were increased in both groups. Compared with Fluvastatin group, Rosuvastatin group had decreased TC and LDL-C (6, 12, 24 months), and increased LDL-C (24 months). With 6, 12, 24 months treatment, the blood lipids reached the standard were more in Rosuvastatin group than those in Fluvastatin group as 35.3%vs 26.1%, 36.4% vs 22.0%, 43.1% vs 31.8% respectively, all P<0.05. With 12 and 24 months treatment, the new-onset diabetes patients in Rosuvastatin group were 11 and 18, in Fluvastatin group were 12 and 17. With 12, 24 months treatment, FBG, 2hPBG levels and the number of new-onset diabetes patients were similar between 2 groups, P>0.05.
Conclusion: Compared with lfuvastatin, the conventional dose of rosuvastatin could better reduce the blood lipids level in ACS patients combing IGT, the effects for preventing ACS patients from IGT to diabetes were similar for both drugs.