Objective To assess the image quality (IQ) of an iterative reconstruction (IR) technique (iDose4) from prospective electrocardiography (ECG)-triggered coronary CTA on a 256 MSCT scanner and determine the optimal dose reduction using IR that can provide IQ comparable to filtered back projection (FBP).Methods Prospectively ECG gated CCTA were performed on 120 patients [76 men,44 women; age:(53 ± 10)y] using a 256-slice MSCT (Brilliance iCT,Philips Healthcare).The control group (Group A,n =30) were scanned using the conventional tube output (120 kVp,210 mAs) and reconstructed using FBP.The other 3 groups were scanned with the same kVp but successively reduced tube output as follows:B (n =30):105 mAs,C (n =30):84 mAs:D (n =30):65 mAs and reconstructed using IR levels of L4 to L6,respectively.All images were reconstructed using the same kernel (XCB).Two radiologists graded IQ in a blinded fashion on a 4-point scale (4-excellent,3-good,2-fair and 1-poor).Quantitative measurements of CT values,image noise,Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were obtained in each group.Analysis of variance (ANOVA) was used for comparisons of objective evaluation indices (noise,CNR) and radiation dose (CTDIvol,DLP,ED) between the four groups.The Kruskal-Wallis test was used for comparisons of demographic data and for detection of differences in subjective evaluation of IQ among groups.A level of P ＜ 0.05 was considered statistically significant.A ROC analysis was performed to determine a radiation reduction threshold up to which excellent IQ was maintained.Results There was no significant differences in objective noise among Groups A (37.4 ±7.9) HU,B(33.2±7.1) HU,C(35.7±9.8) HU,and D(36.0±6.8) HU (F=1.48,P=0.22).There was no significant differences in CNR among Groups A(15.0 ±2.3),B(16.5 ±3.6),C(16.3 ±3.5),and D(15.3±2.8) (F=1.70,P =0.17).Group B and C had good and excellent scores of the subjective IQ (≥3),and there was no significant differences in the scores of the subjective IQ between Group A,and Groups B,C (P =0.30-1.00).Significant differences in image sharpness and study acceptability were observed between groups A and D (P ＜ 0.01).Using the criterion of excellent IQ (score 4),the ROC curve of dose levels and IQ acceptability established a reduction of 60％ of tube output (Group C) as optimum cutoff point (AUC:0.76,95％ CI:0.65-0.87).The effective dose (ED) of Group C was 61％ lower than that of Group A,(1.2 ± 0.1) mSv vs.(3.1 ± 0.6) mSv.Conclusion Iterative reconstruction techniques can provide 61％ ED reduction in prospectively-triggered coronary CTA using 256-slice MSCT while maintaining excellent image quality.

Objective To study the drug resistance of infection bacteria deriving from acute appendicitis patients.Methods The separation and the drug sensitive characteristic of bacteria deriving from the specimen of acute appendicitis patients were ana-lyzed,who were admitted in the general department of our hospital from January to June 2013.Results One hundred and six bacte-ria strains were isolated.Among them,100 (94.34%)strains were Gram negative bacteria strains,including escherichia coli,kleb-siella pneumonia bacillus and verdigris fake single spore bacterium,in a proportion of 67.92%,1 1.32% and 5.66% respectively. The resistance of piperacillin,ciprofloxacin,gentamycin,levofloxacin,tobramycin and cefepime was high in Gram negative bacteria, while the lower resistance to piperacillin/ tazobactam,cefoxitin and imipenem.Conclusion The resistant rate of acute appendicitis infection bacteria is high.

OBJECTIVE:To investigate the role of clinical pharmacists in the anti-infection treatment for gas gangrene chil-dren. METHODS:Clinical pharmacists participated in the anti-infection treatment of a child with gas gangrene;according to clini-cal symptoms and consultation opinions of different departments,it was suggested to use Piperacillin sodium and tazobactam sodi-um for injection for initial anti-infection treatment. After debridement and drainage of left lower limb,removal of necrotic tissue, clinical pharmacists suggested to stop giving Piperacillin sodium and tazobactam sodium for injection and use Benzylpenicillin sodi-um for injection combined with Imipenem and cilastatin sodium for injection instead for anti-infection treatment according to etiolog-ical characteristic of gas gangrene and related guidelines. According to the results of bacterial culture of wound secretion and drug sensitivity test,clinical pharmacists additionally suggested to use Clindamycin hydrochloride and sodium chloride injection 0.6 g, q8 h,ivgtt to inhibit the generation of Clostridium perfringens.According to the changes of patient's signs and etiological results, it was suggested to stop taking Clindamycin hydrochloride and sodium chloride injection,use Vancomycin hydrochloride for injec-tion successively. RESULTS:The physicians adopted the suggestions of clinical pharmacists.After surgical treatment and anti-infec-tion treatment,the patient's condition was improved,the vital signs were stable,and the patient was transferred to the general ward of orthopedics department for further treatment. CONCLUSIONS:Clinical pharmacists participate in the treatment of gas gan-grene child,and assist physicians to formulate and adjust anti-infection treatment plan according to related guidelines,clinical symp-toms,etiological examination results and consultation opinions,so as to guarantee safe and effective drug use.

Objective:To understand the present situation of professional quality in free medical oriented students of different grades so as to carry out targeted education and guidance.Methods:The questionnaire survey was carried out among the 805 Grade 2012 to Grade 2016 students in Chongqing Medical University from December 2016 to January 2017. Grade data were expressed as rate and Spearman's rank correlation was performed using SPSS 17.0 for data analysis.Results:A total of 780 questionnaires were effectively collected in this survey with a recovery rate of 96.9%. Statistically significant differences were found in most items such as the students' ideological and moral quality, clinical practice skills and innovation ability ( P<0.05); no significant differences were observed in the students' theoretical learning quality as well as physical and mental quality ( P>0.05). Conclusion:We demonstrate that it’s necessary to take targeted measures for better guidance of students' professional quality through deeply analyzing the present situation of professional quality in different grade free medical oriented students

Adult ; Female ; Hematoma, Epidural, Spinal ; surgery ; Humans ; Prognosis