ObjectiveTo evaluate the effect of auscultation, partial pressure of carbon dioxide in end-expiration (PETCO2), transillumination technique to judge whether the endotracheal tube is misplaced into the esophagus. Methods A blinded randomized controlled trial was conducted. Sixty patients with American Society of Anesthesiology (ASA) gradeⅠ-Ⅱundergoing endotracheal intubation in Fengxian Central Hospital admitted from September 2014 to February 2015 were enrolled. Two endotracheal tubes with the same size were respectively inserted into the trachea and esophagus for the same depth after general anesthesia by the same person. Two blinded anesthetists with different experience checked the tube position using three methods including auscultation, PETCO2, and transillumination technique, respectively. The order of the tubes tested (trachea or esophagus) and the method used were randomized according to randomise numbers table. The experienced anesthetists conducted the test first, followed by an inexperienced anesthetist conducting the same methods. The numbers of right and wrong determinations with different methods by different anesthetists were recorded.Results Sixty patients underwent the procedures for 180 times, with intratracheal intubation for 90 times, and esophageal intubation for 90 times. It was shown that the results were not different in two groups [96.7% (174/180) vs. 92.2% (166/180),χ2 = 3.500,P = 0.057]. By using auscultation, the correct rate of experienced anesthetist was higher than that of inexperienced (95.0% vs. 78.3%,χ2 = 5.786,P = 0.013). Using PETCO2, both anesthetists were correct in all cases, and the accuracy was 100%. Using transillumination, the experienced anesthetist was mistaken in 3 cases (accuracy was 95.0%), while the inexperienced mistook in 1 case (accuracy was 98.3%), and no significant difference was found between two groups (χ2 = 0.500,P = 0.250). The correct rate of using transilluminaion was significantly higher than that of using auscultation (χ2 = 7.563,P = 0.004). The sensitivity and specificity of the auscultation was 70.0% and 80.0%, that of transillumination technique was 96.7% and 93.3%,and PETCO2 was 100%, respectively, for two groups.ConclusionsPETCO2 is the most reliable method for determining tube position, and it is superior to auscultation and transilluminaion. Transillumintaion technique is superior to auscultation, irrespective of anesthetists' experience, while the accuracy of auscultation showed an obvious relationship with the anesthetists' experience.

BACKGROUND:Colagen sponges are applied for hemostatic use, wound healing, and residual cavity filing, which have great values in clinical application and scientific research.
OBJECTIVE:To investigate the biological properties, biocompatibility and biodegradability of colagen spongesin vivo.
METHODS: The spatial structure, pore diameter and porosity of colagen sponges were characterized by scanning electron microscopy. Transmission electron microscopy was used to observe the conformation of colagen sponges. The secondary structure and thermal denaturation temperature of colagen sponges were
analyzed by circular dichroism spectrum. Colagen sponges were implanted intramuscularly into the spinal cord of New Zealand rabbits to observe the degradation and absorption and histological changesin vivo.
RESULTS AND CONCLUSION: Colagen sponges had porous structure with varying pore sizes ranging
40-150 μm, the mean pore size of 100 μm, the thickness wal of 1 μm, and a porosity of approximately 95.8%. Colagen sponges had a typical porous structure and periodic light and dark zones. The solution of colagen
sponges had a weak positive band near 220 nm and an intense negative band near 206 nm, which indicated a classic triple helix. And the secondary structure and thermal stability of colagen sponges were similar to that of
liquid colagen. Colagen sponges began to degrade at 4 weeks, and remained 20% at 12 weeks. These sponges had been associated with foreign body response and inflammation within 2 weeks after implantation. With wound healing, inflammatory reactions gradualy reduced and disappeared. During the implantation and degradation of sponges, no significant fibrous capsule formed and no tissue necrosis occurred at implantation site, indicating that colagen sponges have good performance in bioactivity, biocompatibility and degradation.

OBJECTIVETo investigate relationship between expressions of hypoxia inducible factor-1alpha (HIF-1alpha) and insulin-like growth factor-II (IGF-II) as well as their correlation with angiogenesis and prognosis in gastric carcinoma.

METHODSHIF-1alpha and IGF-II mRNA expression were analyzed using in situ hybridization, microvessel density (MVD) was determined by anti-CD34 immunostaining in 118 cases gastric carcinoma.

RESULTSThe positive rates of HIF-1alpha mRNA and IGF-II mRNA were 49.2% and 47.4%, respectively. In stage T3-T4 cases, positive rates of HIF-1alpha and IGF-II mRNA expression, the frequencies of vessel invasion, lymph node and distant metastasis were significantly higher than those in stage T1-T2 cases. The mean MVD in stage T3-T4 tumors, vessel invasion, lymph node metastasis and distant metastasis were significantly more frequent than those in stage T1-T2 tumors. The mean MVD in tumors with positive HIF-1alpha and IGF-II mRNA expression was significantly higher than those in tumors without HIF-1alpha and IGF-II mRNA expression. The expression of HIF-1alpha was positively correlated with IGF-II mRNA. There were positive correlations between MVD and expression of HIF-1alpha and IGF-II mRNA, respectively. The mean survival time and 5-year survival rate in cases with positive HIF-1alpha and VEGF expression and MVD value >/= 41.5 were significantly shorter than those in cases with negative HIF-1alpha and VEGF expression and MVD value < 41.5.

CONCLUSIONSHIF-1alpha and IGF-II play an important role in tumor invasion and metastasis, especially in tumor angiogenesis. So test of the expression of HIF-1alpha and IGF-II may act as a useful index of treatment and prognosis.

Adult ; Aged ; Antigens, CD34 ; analysis ; Female ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; genetics ; metabolism ; Immunohistochemistry ; In Situ Hybridization ; Insulin-Like Growth Factor II ; metabolism ; Male ; Middle Aged ; Neovascularization, Pathologic ; genetics ; metabolism ; pathology ; Prognosis ; RNA, Messenger ; genetics ; metabolism ; Stomach Neoplasms ; blood supply ; genetics ; metabolism ; Survival Analysis

OBJECTIVETo investigate mRNA expression of syndecan-1 and heparanase in gastric carcinoma, and their correlation with the growth-pattern, invasion, metastasis and prognosis of gastric carcinoma.

METHODSIn situ hybridization technique was used to examine mRNA expression of syndecan-1 and heparanase in 118 specimens of gastric carcinoma.

RESULTSThe positive rates of syndecan-1 mRNA and heparanase mRNA were 42.4% and 55.9%, respectively. The expression of syndecan-1 mRNA and heparanase mRNA were related to tumor invasion depth (chi(2) = 32.95, P = 0.001; chi(2) = 23.19, P = 0.001), vessel invasion (chi(2) = 46.22, P = 0.001; chi(2) = 33.78, P = 0.001), lymph node (chi(2) = 28.62, P = 0.001; chi(2) = 25.43, P = 0.001) and distant metastasis (chi(2) = 63.30, P = 0.001; chi(2) = 65.76, P = 0.001), and syndecan-1 mRNA positive expression was related to tumor size (chi(2) = 6.25, P = 0.012). There was a negative relationship between Syndecan-1 mRNA and heparanase mRNA expression (r = -0.844, P = 0.001). The mean survival time of cases with low expression of syndecan-1 mRNA was significantly shorter than that of cases with high expression (r = 36.48, P = 0.001), and meanwhile, the mean survival time of heparanase mRNA positive cases was significantly shorter than that of cases with negative expression (r = 34.41, P = 0.001).

CONCLUSIONSThe mRNA expression of syndecan-1 and heparanase can predict the invasion and metastasis of gastric carcinoma, and can be used as markers of prognosis of gastric carcinoma.

Adult ; Aged ; Female ; Follow-Up Studies ; Glucuronidase ; genetics ; metabolism ; Humans ; In Situ Hybridization ; Lymphatic Metastasis ; Male ; Middle Aged ; RNA, Messenger ; genetics ; Stomach Neoplasms ; metabolism ; mortality ; pathology ; Survival Rate ; Syndecans ; genetics ; metabolism

BACKGROUNDAspirin and clopidogrel resistance plays a significant role in the development of cardiovascular ischemic events for ninety patients undergoing percutaneous coronary intervention. Recent studies have indicated that increasing the dose of antiplatelet drugs maybe a potent method to improve the inhibition of platelet aggregation.

METHODSThrombelastograph (TEG) determinations were used to evaluate the effect of antiplatelet therapy. According to the results, 90 patients were divided into three groups and given different doses of aspirin and clopidogrel. Thirty patients with both an inhibition rate of aspirin > 50% and an inhibition rate of clopidogrel > 50% were defined as the control group. Sixty patients with an inhibition rate for aspirin < 50% and an inhibition rate for clopidogrel < 50% were defined as the resistance group. Patients in resistance group were randomly assigned to be given a routine dose (100 mg aspirin plus 75 mg clopidogrel per day, which we called a resistance plus routine dose group, R + R) and a loading dose (200 mg aspirin and 150 mg clopidogrel per day, which we called resistance plus loading dose group, R + L) of antiplatelet therapy. A 12-month follow-up was observed to examine the change of inhibition rate of antiplatelet therapy and to estimate the relationship between inhibition rate and the occurrence of cardiovascular ischemic events.

RESULTSAfter 6 months of antiplatelet therapy, the inhibition rate of aspirin in the R + L group increased from (31.4 ± 3.7)% to (68.6 ± 7.1)%, which was significantly higher than that in R + R group, (51.9 ± 8.2)% (P < 0.01). The inhibition rate of clopidogrel in the R + L group increased from (22.1 ± 3.8)% to (60.2 ± 7.4)%, which was significantly higher than in the R + R group, (45.9 ± 4.3)% (P < 0.01). The occurrence rates of cardiovascular ischemic events, stent thrombosis, recurrent unstable angina and myocardial infarction in the R + R group were 20%, 36% and 17%, respectively. Occurrence was significantly increased compared with that in the control group, 3%, 10% and 1%, respectively (P < 0.01). In contrast, the occurrence rates in the R + L group (10%, 23% and 6%, respectively) were attenuated compared with those in the R + R group (P < 0.01), although still higher than in the control group (P < 0.01).

CONCLUSIONSAlmost all of the cardiovascular ischemic events occurred in the first six months after percutaneous coronary intervention. According to the result of TEG determinations, earlier application of a loading dose of aspirin and clopidogrel can decrease the rate of recurrent cardiovascular ischemic events.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; Aspirin ; administration & dosage ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Myocardial Ischemia ; prevention & control ; Platelet Aggregation ; drug effects ; Platelet Aggregation Inhibitors ; administration & dosage ; therapeutic use ; Prospective Studies ; Thrombelastography ; Thrombosis ; prevention & control ; Ticlopidine ; analogs & derivatives ; therapeutic use

OBJECTIVETo investigate the relationship between apolipoprotein A5(apoA5) - 1131T > C polymorphism and the susceptibility of coronary artery disease (CAD) in Chinese.

METHODSThe restriction fragment length polymorphism of apoA5 gene - 1131T > C was studied using PCR in a case-control study which enrolled 235 patients with CAD diagnosed by angiography and 262 healthy controls from Jiangsu province.

RESULTSThe frequencies of T, C allele were 59.57%ì40.43% and 65.65%, 34.35% in CAD group and control group respectively. There was statistically significant difference in allele frequencies between CAD group and control group (P < 0.05). The susceptibility to CAD for the CC genotype was much higher than that for wild type TT (OR = 1.872, 95% CI = 1.039 - 3.376, P = 0.037), even after the use of Logistic regression models (OR = 2.285, 95% CI = 1.222 - 4.274, P = 0.012). In control group, there was significant difference in TG levels among different genotypes, the C allele carriers had higher serum TG concentration (P = 0.007).

CONCLUSIONapoA5 - 1131T > C polymorphism is associated with an increased risk of CAD and is also in strong association with serum TG levels.

Aged ; Apolipoprotein A-V ; Apolipoproteins A ; genetics ; Asian Continental Ancestry Group ; genetics ; China ; Coronary Artery Disease ; blood ; genetics ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; genetics ; Humans ; Lipids ; blood ; Logistic Models ; Male ; Middle Aged ; Polymorphism, Single Nucleotide ; genetics ; Triglycerides ; blood

Grounding technique is very important to ensure the human safety, imaging devices' safety and the devices' reliable running. This paper expatriates the principles of the grounding safety, interference rejection earth, and the grounding modes and the mode selection for each imaging devices and equipments, and related grounding requirements.
Equipment Safety ; methods ; Magnetic Resonance Imaging ; instrumentation

Objective:To investigate the diagnostic performance of Xpert Mycobacterium tuberculosis/rifampin (Xpert MTB/RIF) assay for pulmonary tuberculosis (TB) in patients with acquired immunodeficiency syndrome (AIDS). Methods:Clinical data of 226 patients with AIDS and suspected pulmonary TB in Shanghai Public Health Clinical Center, Fudan University from July 2017 to November 2019 were retrospectively analyzed. Fluorescence staining microscopy of sputum smear, BACTEC MGIT 960 liquid culture (or Roche solid culture) and Xpert MTB/RIF assay were implemented respectively. The sensitivity and specificity of Xpert MTB/RIF in the diagnosis of Mycobacterium tuberculosis (MTB) infection and rifampin resistance were analyzed. Results:Totally 226 patients of suspected pulmonary TB were enrolled. There were 94(41.6%) patients had positive mycobacterium culture, in which 51 (54.3%) were MTB and 43 (45.7%) were nontuberculous mycobacteria (NTM). Using the positive MTB culture of sputum and mycobacterial protein from BCG of Rm 0.64 in electrophoresis (MPB64) as reference standard, the sensitivity and specificity of Xpert MTB/RIF assay for MTB diagnosis were 72.6%(95% confidence interval ( CI) 66.7%-78.4%) and 97.1% (95% CI 95.0%-99.3%), respectively. The sensitivity and specificity of Xpert MTB/RIF assay for MTB diagnosis in patients with positive sputum smear were 76.7%(95% CI 67.7%-85.8%) and 90.0(95% CI 83.6%-96.5%), respectively. The sensitivity and specificity of Xpert MTB/RIF assay for MTB diagnosis in patients with negative sputum smear were 50.0%(95% CI 41.8%-58.2%)and 99.3%(95% CI 97.9%-100.0%), respectively. With phenotypic resistance as reference standard, the sensitivity and specificity of Xpert MTB/RIF assay for rifampicin resistance were 75.0% and 100.0%, respectively. Conclusion:Among AIDS patients, the performance of Xpert MTB/RIF assay for pulmonary TB diagnosis is pretty good and could differentiate MTB from NTM rapidly, which has good application value.

Objective To evaluate the imaging methods,characteristics,diagnostic value of multi- slice CT urography(MSCTU)in congenital abnormities of urinary system.Methods To collect 33 urinary congenital abnormities cases in three years and to analyses these MSCTU images.All examinations were performed with a multi-slice spiral CT scanner.The patients were intravenously injected with 90 ml of Iohexol 300 with a power injector at the rate of 3 ml/s.Nephrographic-phase images were obtained at 75 s after initiation of the injection of contrast material,the appropriate delay time is according to Kidney's enhancement extent and nephrohydrosis degree.Excretory-phase images were obtained through the abdomen and pelvis from 10 min.to 23 h after initiation of the injection of contrast material without abdominal compression.Excretory-phase images were transferred to the workstation and performed maximun intensity projection(MIP),multiplanar reconstruction(MPR),volume rendering(VR),and virtual cystoscopy (VC).Results The urinary congenital abnormities diagnosed by MSCTU in 33 cases,including 1 ectopic kidney,1 horseshoe kidney,1 renal malrotaion,2 supernumerary kidneys,2 ureteral valves,2 retrocaval ureters,4 congenital megaureters,6 ureteropelvic junction stenosis,9 pelviureteric duplication malformations and 5 bladder diverticula.The displaying rate of ureter was 91%(61/66).The scanning time of excretory-phase was less than 20 seconds in All cases.The average CT value of contrast media in displayed ureter lumens was 520 HU.The postprocessing images had clear,dimensional feature and It was satisfy the diagnosis.Conclusion MSCTU has clear,dimensional feature and has strong ability of displaying total anatomy shape and tiny pathology change of congenital abnormities in the urinary system.It is a very useful method for detecting the congenital abnormities in the urinary system.

Objective To evaluate the application of the dual-energy CT (DECT) in detection of monosodium urate (MSU) crystals in gout patients.Methods The imaging and clinical data of 101 patients with suspected gout were retrospectively analyzed,including 64 cases of clinically diagnosed gout (gout group) and 37 non-gout cases (non-gout group).The DECT examination was performed for 85 joints in gout group and 42 joints in non-joint group.The value of DECT in detection of MSU crystals was evaluated with receiver operating characteristic (ROC) curve.Results There were significant differences in gender (x2=5.32,P=0.03) and blood uric acid levels (t=1.95,P=0.04) between gout and non-gout groups.The detection rate of MSU in gout group was significantly higher than that of non-gout group (x2=30.52,P＜0.001).The area under the ROC curve (AUC) of DECT in detection of was 0.74±0.05 (Mean±SE),95％CI:0.64-0.85.The sensitivity,specificity,positive predictive value and negative predictive value of the DECT in detection of gouty stone was 0.844,0.703,83.1％ and 72.2％,respectively.Conclusion The dual-energy CT has high sensitivity,specificity and reliability for the detection and diagnosis of monosodium urate crystals in joints of gout patients.