Objective To study MR manifestations of biliary obstructive disease.Methods MR examination (Philips Gyroscan INTERA 1.0T)in 69 patients with biliary obstructive disease were performed.The conventional sequences included:T1WI/FFE,T2WI/TSE,T2WI/SPIR and contrast-enhanced at axial position,coronal B-FFE and MRCP.All images in all cases were compared with the results of operation and pathology.Results 43 cases were benign disorder,of them,42 cases were choledocholithiasis,one case was choledochal cyst.Choledocholithiasis presented as single or multiple round or ovoid with low signal.The direct sign of malignant lesions (26 cases) was the masses with slightly high signal at the obstructive part,the indirect sign of malignant lesions was obstruction or narrow of bile duct. The MR diagnostic accuracy of obstructive location was 100%, and the accuracy for evaluating the causes of obstruction was 89.9%.Conclusion MRCP combining with B-FFE and routine MRI, analysising the direct sign and indirect sign, can improve the diagnostic accuracy of obstructive jaundice.

Objective To provide reference for focusing and improving policy efficiency in China by establishing the conceptual model and index system of effectiveness of Township and Village Health Services Integration Policy(TVI).Methods The conceptual model and index system of TVI effectiveness were established by literature review and Delphi method.Comprehensive Index Method and Weighted TOPSIS Method were used in index consistency check.Results The conceptual model and index system of TVI effectiveness contain four conceptual modules,8 policy goals and 27 evaluation indexes.The positive coefficient of experts is 0.95 and authoritative grades of experts are more than 0.90.Conclusion Based on SPO Model,the conceptual model and index system of TVI effectiveness in China have been established,which consists three aspects:construction of organization system,health services and satisfaction.

Objective To investigate the effects of hepatocyte growth factor(HGF) on proliferation and collagen synthesis induced by angiotensin Ⅱ(AngⅡ)in SD rat cardiac fibroblasts(CFbs),and determine the role it plays in hypertensive ventricular remodeling.Methods CFbs in SD rat were cultured in vitro and treated with different concentrations of AngⅡ and/or HGF.Collagen type Ⅰ synthesis of CFbs was measured by Western blotting,and proliferation of CFbs was detected by MTT assay. Results AngⅡ promoted collagen synthesis and proliferation in CFbs in a certain concentration range,which can be significantly inhibited by HGF. ConclusionHGF can inhibit the proliferation and collagen synthesis induced by AngⅡin SD rat CFbs,and may protect against hypertensive ventricular remodeling.

Objective To investigate the characteristics and plausible mechanisms of attention network impairments in hyperthyroid patients.Methods 34 hypertyroid patients and 33 normal controls performed the attention network test (ANT),which was used for assessing three components of attentional networks including alerting,orienting,and executive control.Results The mean scores for alerting and orienting networks were significantly shorter (P ＜ 0.01) in hyperthyroid patients (respectively,(20.00 ± 22.47) ms,(35.26 ± 22.65) ms)than those in normal controls (respectively,(35.70 ± 17.62) ms,(50.61 ± 23.66) ms).The mean reaction time for executive control network was significantly longer(P ＜ 0.01) in hyperthyroid patients((116.71 ± 40.36)ms)than those in controls ((93.00 ± 29.34)ms).Triiodothyronine(T3) and thyroxine(T4) were positively correlated with the scores for executive control network (respectively,r=0.350,P＜ 0.05; r=0.417,P＜ 0.05) in hyperthyroid patients,whereas no relationship was found between thyroid stimulating hormone(TSH) and the value of executive control network.T3,T4 and TSH were not correlated with the value of alerting and orienting network in hyperthyroid patients.Conclusion Hypertyroid patients have extensive impairments in various kinds of attentional network,rather than a specific deficit.The recession of executive control network accompanies with enhancement of serum levels of T3,T4 in hyperthyroid patients.

Background Researches showed that microperimetry can exhibit more tiny visual function damage than conventional perimetry in glaucomatous eyes.However,the study on fixation stability of glaucoma is still rare until now.Objective This study was to compare the correlation between microperimetry Maia (Macular Integrity Assessment) and Humphrey perimetry,and to investigate the changes of the fixation stability in glaucoma patients with hemifield defect.Methods This study proposal was approved by Medical Ethic Committee of Peking University First Hospital.A cross-sectional study was performed under the informed consent of each subject.Thirtyfive eyes of 35 glaucoma patients with hemifield defect by 24-2 Humphrey perimetry were included in Peking University First Hospital from December 2013 to March 2014,and 30 eyes of 30 normal volunteers served as controls.Both Humphery (10-2) and Maia (expert 10-2) were performed on the subjects respectively and the correlation of the results between Humphery (10-2) and Maia (expert 10-2) were analyzed.Then the patients with normal hemifield on Humphrey were assigned to Maia normal group and Maia abnormal group.Fixation stability differences were compared between glaucoma group and normal control group,and between Maia normal group and Maia abnormal group.Results The moderately positive correlation was found in the mean sensitivity between Maia microperimetry and Humphrey perimetry (r=0.403,P =0.001),and the average threshold of Maia microperimetry was moderately positive correlated with the mean defect (MD) of Humphrey perimetry in glaucoma patients (r=0.438,P =0.008).The fixation stability parameter P1 was (67±17)％ and (87±10)％,and that of P2 was (70±16)％ and (88±9)％;the 63％ bicurve elipse area (BCEA) was (5.08±1.55) °2and (2.21±0.60) °2,and the 95％ BCEA was (14.74± 6.04) °2 and (2.86 ± 1.17)°2 in the glaucoma group and normal control group,respectively,showing significant decreases of P1 and P2 and increases of 63％ BCEA and 95％ BCEA in the glaucoma group compared with the normalcontrol group (t=-5.604,-4.831,9.885,11.086,all at P=0.000).In Maia normal group and Maia abnormal group,the P1 was (79±8)％ and (63±17)％,the P2 was (81±10)％ and (67±16)％,the 63％ BCEA was (3.19±0.65)°2 and (5.70±1.22)°2 and the 95％ BCEA was (9.10±2.60)°2 and (19.35±5.01)°2,respectively.Compared with the Maia normal group,the P1 and P2 were significantly lower,and 63％ BCEA and 95 ％ BCEA were higher in the Maia abnormal group (t=-2.468,P=0.019;t=-2.371,P=0.024;t =5.514,P=0.000;t=5.575,P=0.000).Conclusions Maia microperimetry and Humphrey perimetry yield a good correlation for glaucomatous macular function examination.In addition,Maia microperimetry showed that fixation stability decreased in glaucoma patients with hemifield defect.

OBJECTIVETo investigate the effect of propofol on brain regions at different sedation levels and the association between changes in brain region activity and loss of consciousness using blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) and bispectral index (BIS) monitoring.

METHODSForty-eight participants were enrolled at Peking Union Medical College Hospital from October 2011 to March 2012 and randomly assigned to a mild or a deep sedation group using computer- generated random numbers. Preliminary tests were performed a week prior to scanning to determine target effect site concentrations based on BIS and concomitant Observer's Assessment of Alertness/Sedation scores while under propofol. Within one week of the preliminary tests where propofol dose-response was established, BOLD-fMRI was conducted to examine brain activation with the subject awake, and with propofol infusion at the sedation level.

RESULTSMild propofol sedation inhibited left inferior parietal lobe activation. Deep sedation inhibited activation of the left insula, left superior temporal gyrus, and right middle temporal gyrus. Compared with mild sedation, deep propofol sedation inhibited activation of the left thalamus, precentral gyrus, anterior cingulate, and right basal nuclei.

CONCLUSIONMild and deep propofol sedation are associated with inhibition of different brain regions, possibly explaining differences in the respective loss of consciousness processes.

Adult ; Brain ; drug effects ; Consciousness Monitors ; Deep Sedation ; Dose-Response Relationship, Drug ; Humans ; Hypnotics and Sedatives ; pharmacology ; Male ; Propofol ; pharmacology

Objective To investigate the effects of three laparoscopic bariatric operations on relieving type 2 diabetes in morbid obese patients. Methods From 2005 to 2009, 15 morbid obese patients with type 2 diabetes received bariatric operations in Shengjing Hospital including lapband operation (7 cases) , sleeve gastrectomy (7 cases) and gastric bypass(4 cases). All patients were followed up for more than 1 year. Results All patients recovered without major complications. Body weight decreased and BMI was respectively (27. 6 ± 2. 0) kg/m2, ( 26. 9 ± 1. 4) kg/m2 and (27. 5 ± 3. 0) kg/m21 year after operation. The excess BMI loss in three groups were (76. 4% ± 6. 8% ) , (83. 7% ± 4. 6% ), (85. 7% ±9. 5% ) 1 year after operation. On the other side, the fasting glucose levels and glycohemoglobin in gastric bypass group were much lower than that in other two groups. Conclusion All these operations were effective in controling the weights and fasting glucose levels, while the gastric bypass method is better than other two methods in weight and serum glucose control. Sleeve gastrectomy was better in weight and glucose control than lap band operation.

Objective Currently,pediatric 18F-FDG dose and acquisition durations are generally based on coarse extrapolation from adult guidelines.This study sought to determine whether shorter acquisition durations or a lower 18F-FDG injected activity could be used during pediatric 18F-FDG PET/CT examinations while maintaining diagnostic utility.Methods Thirty-six whole-body 18F-FDG PET/CT examinations were performed on 36 patients (weight,13-89 kg,(46.51±5.63) kg; age range,3-14 years old,(9.22±3.16) years old) with a weight-based injected activity (5.3 MBq/kg (0.144 mCi/kg)),fixed acquisition durations 180 S/FOV,VIP record acquisition mode using Discovery STE.For each examination,the Vip-mode data was truncated to form multiple datasets with shorter acquisition durations down to a minimum of 60 s/FOV (i.e.,60,80,100,120,140,160 s/FOV data were formed from single 180 s/FOV acquisition).168 image volumes were generated,randomized,and reviewed in a masked manner with corresponding CT image volumes by 6 radiologists.Overall,subjective adequacy and objective lesion detection accuracy by body region were evaluated.Results All examinations with maximum acquisition duration were graded as adequate and were used as the reference standard for detection accuracy.For patients more than 30 kg,when acquisition duration was more than 120 s/FOV,all PET/CT examinations were graded as adequate for clinical tasks,whereas,when acquisition duration was reduced to less than 120 s/FOV,lesion detection became less accurate.For patients less than 30 kg,lesion detection accuracy was perfect for acquisition times between 140 s/FOV and 180 s/FOV for all regions of the body.However,lesion detection became less accurate when imaging acquisition time was reduced less than 140 s/FOV.Conclusions When GE Discovery STE PET/CT was applied during pediatric PET/CT examination,using decreased acquisition times as a surrogate for 18F-FDG dose,18F-FDG dose can be reduced by approximately 33.33％ when patients weigh over 30 kg were scanned for 180 s/FOV.For patients less than 30 kg,18F-FDG dose can be reduced by approximately 22.22％ without losing diagnostic quality.Reduction of overall scan time potentially reduces motion artifacts,improves patient comfort,and decreases length of sedation.Alternatively,decreased 18F-FDG dose minimizes radiation risk.

Objective To investigate the effect of early low-glucocorticoid on hemodynamics and prognosis in the patients with septic shock.Methods Sixty patients with septic shock failing in active fluid resuscitation and vasoactive drugs in our hospital from June 2013 to August 2015 were selected and divided into the control group,early-hormone group and late-hormone group.MAP,HR,PO2/FIO2 and serum lactic acid levels were monitored in all selected patients before treatment and at 12,24,48 h after treatment.Apache Ⅱ,SOFA scores were assessed before treatment and on 1,3,7 d after treatment.The ventilation time,ICU stay time,hospital stay time and intravenous use time of vasoactive agents(VDNT) were recorded.Results The Apache Ⅱ scores and SOFA scores on 3,7 d after treatment in the early-hormone group were significantly decreased compared with the late-hormone group and control group (P＜0.05).MAP and HR at 24,48 h after treatment in the early-hormone group were significantly improved compared with the late-hormone group and control group (P＜0.05).The level of serum lactic acid at 12,24 h after treatment in the early-hormone group and late-hormone group were obviously lower than that in the control group,the levels of serum lactic acid at 12,24 h after treatment in the early-hormone group were obviously lower than those in the late-hormone group (P＜ 0.05).PO2/FIO2 at 12 h after treatment in the early-hormone group and late-hormone group were obviously better than that in the control group,and PO2/FIO2 at 12 h after treatment in the early-hormone group was obviously better than that in the late-hormone group(P＜0.05).The ventilation time,ICU stay time,hospital stay time and VDUT in the early-hormone group were significantly shortened compared with the late-hormone group and control group.The ventilation times,ICU stay time and VDUT in the latehormone group were significantly shortened compared with the control group (P＜0.05).Conclusion Early using low-dose glucocorticoid may restore hemodynamics more quickly,protects the organ function and improves the prognosis in the patients with septic shock.

Objective To evaluate the correlation between 3 different instruments,SF-36 Health Survey,Hospital for Special Surgery (HSS) knee score and Rasmussen Score,for measurement of surgical outcomes of tibial plateau fractures,and their clinical significances as well.Methods Included in this study were 94 patients with tibial plateau fracture who had been consecutively treated and followed up from January 2009 through February 2015 at our department.Their surgical outcomes were measured by SF-36 Health Survey,HSS-knee score and Rasmussen Score respectively for health-related quality of life (HRQL),knee function,and reduction of fracture.Pearson correlation test was used to determine the correlation between the 3 measurement instruments.Results 94 cases eventually finished their following-ups.The mean follow-up was 41.2 months (range,from 12 to 75 months).The Rasmussen scores for their first postoperative X-ray films averaged 14.7 ± 2.1 points,their HSS-knee scores at the final follow-up averaged 81.0 ± 13.7 points,and their SF-36 scores at the final follow-up averaged 85.5 ± 10.0 points.Statistical analysis showed that the HSS-knee score was positively related to the SF-36 score and Rasmussen score (P ＜ 0.05) but not to the Rasmussen score (P ＞ 0.05).Conclusions Fine reduction may be the basis for good functional recovery of the knee and good functional recovery may benefit the HRQL of the patients,but merely good fracture reduction does not promise a high HRQL for patients with tibial plateau fracture.In the treatment of tibial plateau fractures,it is not enough to take care of fracture reduction and functional recovery,and the HRQL of patients should be taken into consideration.More attention should be paid to other important factors influencing the HRQL of patients.