Objective The sensitivity and specificity of 18 FDG PET/CT are poor in the diagnosis of gastric cancer .Gastric signet ring cell carcinoma and Mucinous gastric carcinoma is known to have low fluorodeoxyglucose (18FDG) uptake,but not known for poorly differentiated gastric adenocarcinoma .This study was to investigate the value of 18 FDG PET/CT in the diagnosis of poorly differ-entiated gastric adenocarcinoma . Methods We retrospectively analyzed the results of 18 FDG PET/CT of 34 cases of histologically confirmed poorly differentiated gastric adenocarcinoma .We recorded the volume , location , and gastric wall invasion depth , and maxi-mum standardized uptake value ( SUVmax) of the tumors and analyzed the relationship of 18 FDG uptake with the clinicopathologic pa-rameters. Results By 18 FDG-PET/CT, poorly differentiated gastric adenocarcinoma was diagnosed in only 67.6% of the patients (23/34).SUVmax was found to be significantly correlated with age , gastric wall invasion, and tumor size (P<0.05), but not with gender , tumor location , tumor pathologic subtype , lymph node metastasis , and distant metastasis ( P>0 .05 ) .Logistic regression a-nalysis showed the tumor size to be the sole factor influencing the 18 FDG uptake of poorly differentiated gastric adenocarcinoma ( OR=0.37, 95%CI 0.154-0.920, P=0.03). Conclusion The di-agnostic value of 18 FDG-PET/CT is but limited for poorly differentia-ted gastric adenocarcinoma , and attention should be paid to its false-negative results .

Objective: To study the properties and behavior of dynamics in the tactical reserve models of medicine supplies. Methods: A tactical reserve model of medicine supplies was established with methods of systematic dynamics, and the behaviors of the system was simulated by computer program when parameters changed. Results:The quantity of initial reserve did not obviously effect the average inventory and amount of goods in short. However, objective reserve, rate of supply and rate of deliver evidently affected average inventory and amount of goods in short. Conclusion: The system efficiency is not influenced if the rate of supply is guaranteed.

Objective To analyze the value of predict lymph node status according to the tumor size, solid size, and maximum standardized uptake value(SUVmax) in adenocarcinoma of the lung with a size of ≤3 cm. Methods One hundred and thirty-six patients who had undergone curative resection for lung adenocarcinoma were enrolled in this retrospective study.The largest transverse sectional diameter of the tumor and solid size were measured. Then SUVmax of the main tumor was assessed. Logistic regression analysis was performed by taking the lymph node status as the dependent variable,and the size of solid component of tumor, SUVmax were taken as independent variables. The predicted probability of the Logistic regression model was enrolled in receiver operating characteristic analysis.Results Among the 136 cases of lung adenocarcinoma, the incidence of lymph node metastasis was 24.3%(33/136). Logistic regression analysis showed that the size of the solid component (OR 3.880, 95%CI 1.788 to 8.421, P<0.05) and SUVmax (OR 1.179, 95%CI 1.024 to 1.357, P<0.05) at baseline predicted the metastasis of lymph node independently. And the size of tumor was non-independent predict factor (OR 1.238, 95%CI 0.360-4.260, P>0.05). The ROC curve analysis was performed based on the predicted probability of Logistic regression model, and the area under the curve was 0.838(P<0.01) Conclusions Solid size and SUVmax are important predictors for lymph node metastasis of lung adenocarcinoma with a size of ≤3 cm, and it may be helpful to avoid unnecessary limited resection or lymph node dissection.

Objective To compare the thin-section CT findings of pulmonary candidiasis,aspergillosis and eryptococcosis wim histopathology in immunoeomprimised rabbits and impmve the diagnostic accuracy of fungus infection. Methods Heathy New Zealand white rabbits were used for immunoeompromised animal models.Thin-section CT scan was performed before and 2,4,6,8,10,12,14 d after inoculation.The pattern and distribution of the pulmonary abnormalities were retrospectively assessed by two thomeic radiologists and compared with histopathology.The granulocyte count was compared before and after administration of immunosuppressive agents.The pmred t test,chi square test and the Fisher's exact test were used for the statistics.Results Fourteen rabbits had candidiasis.16 rabbits had cryptocoecosis,15 rabbits had aspergillosis.The granulocyte counts before and after administration of immunosuppressive agents were(2.91±0.92)and(0.35±0.19)×109/L respectively in eandidiasis group,there was a significant difference(t=12.484,P＜0.05);(2.51±0.82)and(0.76±0.71)×109/L in aspergillosis group,there was a significant difference(t=5.792,P＜0.05);(2.10±0.65)and (0.48±0.22)×109/L in cryptococcosis group,there was a significant difference(t=8.199,P＜0.05).The onaet time of infections on CT were not significantly different in three groups (P＞0.05).Ground glass opacity (GGO) and consolidation were the two most colnlnon findings in immunocompromised rabbits with three fungus infections,areas of GGO was correlated with the congestion,hemorrhage,inflammatory cell infiltration and interstitial hyperplasia in pathology. Consolidation was correlated with the severe congestion,hemorrhage, inflammatory cell infiltration, interstitial hyperplasia, necrosis and vascular embolism in pathology. Conclusion GGO and consolidation are the two most common findings of fungus infections in immunocompromised animal models and thin-section CT findings can reflect the pathological changes.

Objective To investigate the expression of P21ras and PIK3CA proteins in hepatitis B virus-related hepatocellular carcinoma(HBV-HCC), post-hepatitis B hepatic cirrhosis (HBV-hepatic cirrhosis)and normal hepatic tissues specimen, and their correlation between HBV-HCC and HBV-hepatic cirrhosis tissues.Methods Using immunohistochemistry, the expression of P21ras and PIK3CA proteins in 34 cases of HBV-HCC, 37 cases of HBV-hepatic cirrhosis and 30 cases of normal liver tissues specimen were detected and compared. Results The mean gray scales of P21ras protein in HBV-HCC, HBV-hepatic cirrhosis and normal hepatic tissue specimen were 138.86 ± 2.9, 145. 34 ± 2.06 and 152.07 ± 1.17 (P ＜ 0. 0l), respectively, and were related to the progression of hepatopathy (P ＜0.01). The mean gray scales of PIK3CA protein in HBV-HCC, HBV-hepatic cirrhosis and normal hepatic tissue specimen were 138.20 ± 3. 14, 149.49 ±0. 78 and 154.71 ± 1.29 (P ＜ 0.01), respectively, and were related to the progression of hepatopathy (P ＜ 0. 01).There were apparent correlation between P21ras and PIK3CA in HBV-HCC and HBV-hepatic cirrhosis respectively (r =0. 64, P ＜0. 05; r =0. 42, P ＜0. 05). Conclusion The overexpression of P21ras and PIK3CA in HCC and hepatic cirrhosis tissue suggests that they participate in the tumorigenesis and development of hepatocellular carcinoma and hepatic cirrhosis, and there may be a signal transduction pathway of P21ras-PI3K in HBV-HCC and HBV-hepatic cirrhosis.

Objective To make comparison of duration of subarachnoid block with intrathecal ropivacaine between gravidas with diabetes mellitus and non-diabetic pregnancy, to evaluate the sensitivity of parturient with diabetes to ropivacaine. Methods 75 parturients who were presenting for elective cesarean section were randomly divided into pregestational diabetes mellitus group (group P, n=15) , gestational diabetes mellitus group (group G, n=30) and non-diabetic parturients group (group N, n=30). After entering the operating room, parturients were given spinal anesthesia spinal at the L3～4 interspace with 0.5％ hyperbaric ropivacaine 3 ml with left lateral decubitus position. To determine the level of sensory block by 10 g monofilament and evaluate the motor block with modified Bromage score. To record the time T6 sensory level was obtained, the onset time of sensory block, motor block, the duration of the motor block and sensory block. Results The time T6 sensory level was obtained of Group P were significantly shortened (P < 0.001). Compared with Group N and Group G, the duration of sensory (P < 0.001) and motor (P < 0.001) block were significantly prolonged. Conclusion Parturients with pregestational diabetes mellitus are more sensitive to 0.5％ hyperbaric ropivacaine compared to non-diabetic parturients. Compared with non-diabetic parturients, there are no difference in the sensitivity of parturient with gestational diabetes mellitus to 0.5％hyperbaric ropivacaine.

Objective To observe the effect and safety of intermittent epidural bolus without background infusion combined with patient-control epidural analgesia (PCEA) in transurethral resection of prostate. Methods Sixty patients with benign prostatic hyperplasia in Shengjing Hospital of China Medical University from January to August 2018 were selected, and the patients were treated with transurethral (plasma) resection of prostate. The patients were divided into test group and control group according to the random digits table method with 30 cases each. Postoperative epidural analgesia of 2 groups used the electronic analgesia pump. The analgesia mode of test group was intermittent epidural bolus without background infusion combined with PCEA, and the analgesia mode of control group was continuous infusion combined with PCEA. The visual analogue score (VAS), Ramsay sedation score, improved Bromage score, adverse reaction and satisfaction of patients end of surgery to 48 h after operation were compared between 2 groups. Results There were no statistical difference in VAS and Ramsay sedation score between 2 groups (P＞0.05). The improved Bromage score 6 h after operation in test group was significantly lower than that in control group: 0 (0, 0) score vs. 0.5 (0, 1.0) scores, there was statistical difference (P＜0.05). The dosage of electronic analgesic pump 48 h after operation in test group was significantly lower than that in control group: (159.73 ± 22.58) ml vs. 250 ml, there was statistical difference (P＜0.01). The patients in 2 groups were satisfied, and there was no obvious dissatisfaction. There was no statistical difference in incidence of adverse reaction between 2 groups (P＞0.05). Conclusions In the postoperative analgesia of transurethral (plasma) resection of prostate, intermittent epidural bolus without background infusion combined with PCEA can decrease the drug dosage without the decline of analgesia.

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Objective To get well-informed of the current status of emergency training in primary hospitals in Sichuan Province and to find weaknesses in the system in order to provide scientific basis for emergency knowledge and skills training.Methods A stratified random cluster sampling method as adopted and an anonymous questionnaire survey method was conducted to investigate the basic circumstances of the current training and the training needs of 1 000 emergency medical staff in 9 regions throughout Sichuan Province.Results The scope of the survey covered emergency doctors,nurses and technicians in hospitals of Grade Ⅱ,Grade Ⅲ and below.A total of 1 000 surveys were sent out and 983 were recovered.The questionnaire completion rate was 98.3％.The respondents mainly worked for more than 10 years,most of which with Bachelor degree,junior and intermediate titles.Results of the survey showed,63.1％ Most respondents have only one or two training opportunities per year.The training methods are mainly continuing education (59.0％,580 trips),training organized within the unit (58.5％,575 trips),and training organized by health administrative units (39.3％,386 trips).The main contents of the training are:basic professional skills learning (66.7％,655 trips),basic professional theoretical study (59.2％,582 trips),and new emergency technology (42.5％,418 trips),only 32.0％ of the respondents believe that these methods meet the practical needs.The main factors that influence participation in the training were:not be arranged by employer (36.2％,356 trips);the training was different from actual work (31.6％,311 trips);no replacement for work so they couldn't join training (29.8％,293 trips).The survey showed that the most desirable way of training is:practical application (60.1％,591 trips) and the most desirable training content is:emergency first aid knowledge (73.7％,724 trips).There were significant differences in case discussion,technical observation,academic lectures,special study trainingand learning methods in hospitals of different levels (P＜0.05),but there was no significant difference in the choice of professional practice methods (P＞0.05),and the selection of training contents was in emergency first aid knowledge,general medical knowledge and prevention and treatment of chronic diseases.There was no statistical difference in the selection of training contents of knowledge,infectious disease knowledge and department management knowledge (P＞0.05).There were significant differences in the choice of nursing knowledge training (P＜0.05).Conclusion The current situation showed a lack of first-aid knowledge and skills training for emergency personnel in Sichuan Province.The present situation of skill training can't satisfy the need of their desire to participate in training.It is urgent to develop a standardized,systematic and scientific training mode to improve the emergency first aid ability of primary medical and emergency personnel.

We report the successful management of a pregnant woman with para-Bombay phenotype. The woman received routine prenatal check-ups and underwent vaginal delivery in the Affiliated Shenzhen Maternity & Child Healthcare Hospital. Blood grouping at 12 weeks of pregnancy showed that the forward typing of the patient was group O, but reverse typing indicated group AB. Her ABO genotype was determined as ABO*A1.02/B.01. There was c.551-552del AG and c.880-882 del TT in the FUT1 gene, and 357C>T and 716G>A in the FUT2 gene. Thus, her FUT1 genotype was h1/h2 and FUT2 genotype was Se/Se. No significant abnormalities were found in the routine prenatal examination. A male infant was born vaginally at 39 +2 gestational weeks, who was grouped as B-positive without neonatal hemolytic disease. Para-Bombay is a rare blood group. It is necessary to clarify the blood type during prenatal examination and develop a management strategy for those with special blood groups to reduce the incidence of postpartum hemorrhage and ensure safe delivery.