Objective To simulate the hemodynamic feature in cerebral bridging veins (BVs), in order to provide a morphologic basis for the pathogenesis explanation and imaging diagnosis of cerebral venous thrombosis (CVT). MethodsTotally 6 human cadavers (12 sides) were examined in this study. Each head of the cadavers was injected with blue-coloured latex via the superior sagittal sinus (SSS) and internal jugular veins. The diamter and the angle of BVs entering SSS were measured. Based on the data of cadavers and computational fluid dynamics software pack, the hemodynamic models were established. The wall shear stress (WSS) was carefully studied and compared between different models. Results The total of 137 BVs formed two clusters along the SSS: anterior group and posterior group. Compared with anterior group BVs, the diameter of posterior group BVs was large, and the angle was smaller. In 137 models,when the diameter of a BV was more than 1.2mm, and the angle was between 65 and 105 degree, the local WSS decreased in the downstream wall of SSS. When the diameter of a BV was more than 1.2mm, and the angle was less than 65 degree, the local WSS decreased in the downstream wall of SSS and the upstream wall of BVs. The minimum WSS in BVs was 63% of the minimum WSS in SSS. Compared with the anterior group BVs, the minimum WSS in the wall of posterior group BVs was samller, and the distance from the minimum WSS to the dural entrance was longer. Conclusion CVT occurs easily when the diamter of a BV is more than 1.2mm and the angle is less than 65 degree. The embolus forms early in the upstream wall of BVs entering the posterior part of SSS.

BACKGROUND:A large number of literatures have shown that surgeons expose to a higher radiation dose during puncture and bone cement injection in percutaneous vertebral augmentation. OBJECTIVE:To review the research progress in radiation doses and safeguard procedures in percutaneous vertebral augmentation. METHODS: By using percutaneous vertebral augmentation, radiation doses, radiation protective as key words, we retrieved articles related to radiological protection during percutaneous vertebral augmentation published from January 1995 to December 2014 in Wangfang database and PubMed database. RESULTS AND CONCLUSION:One basic principle of radiation protection is that the radiation dose decreases rapidly with distance from the radioactive sources. Surgeons should maximize the distance from the radioactive sources as far as possible in case there is no effect on the operation. To optimize the setting and position of C-arm machine, wear protective devices and put lead shields as wel as computer navigation and radiation training in surgeons al can help to reduce the radiation doses during percutaneous vertebral augmentation. Remote bone cement injection device is easy to control but not increases the radiation doses. In addition, the influence of surgery bed on radiation dose remains to be further studied. We believe that with the in-depth research on radiological protection, vertebral augmentation technique wil be safer in clinical application.

Objective To learn the overall results of the final test paper in nursing undergraduates of Peking Union Medical College, and to provide the theoretical support for teaching quality assessment of nursing undergraduates.Methods The difficulty coefficient, the discrimination index, the reliability (Cronbach α coefficient) and the degree of coverage were analyzed based on education measurement and education statistical methods.Results The mean total score was 67.8±12.5, ranged from 38 to 95.The difficulty coefficient, the discrimination index and the Cronbach α coefficient were 0.68, 0.30 and 0.71 respectively.The rates of loss score were 33.8% for choice questions, 37.2% for completion questions, 22.5%for true or false questions and 24.8% for calculation questions respectively.Among the total 30 examination questions, the proportions of the most difficult ones, the difficult ones, the moderate ones, the easy ones and the easiest ones were 30.0%,13.3%,20.0%,20.0% and 16.7% respectively.28 examination questions (93.3%) had the best or better discrimination.Conclusions The test paper held the moderate difficulty and the good discrimination, reliability and the degree of coverage.The results of the examination accurately reflect the knowledge and ability of the students.In addition, more attention should be paidto improve the knowledge of nursing undergraduates on the importance of the medical statistics in medical scientific research.

10.3969/j.issn.2095-4344.2013.25.008

OBJECTIVETo investigate the value of MRI follow-up in pediatric patients with spinal tuberculosis.

METHODSFrom February 2004 to April 2013, MRI imaging data in 21 children with spinal tuberculosis by pathologically and clinically proven were retrospectively analysed. There were 11 males and 10 males, with an average age of 9.4 years old ranging from 2 to 14 years old. Eighteen patients were received conservative treatment, 3 patients were treated by surgical operation. The course of disease ranged from 2 months to 3 years. All cases underwent two or more MRI examinations for follow-up. MRI findings of the first and second examination were comparatively analyzed,including signal changes of vertebral body and intervertebral, paraspinal abscess and the change of kyphosis angle.

RESULTSIn the 21 cases with tuberculosis, 85 vertebral bodies were affected in total, including 10.6%(9/85), 49.4%(42/85) and 40%(34/85) vertebral bodies separately in the cervical,thoracic, lumbosacral spine. Follow-up MRI showed vertebral body shape and signal had no obvious change during or after treatment, 15 cases with vertebral bodies changed flat or cuneate, 10 cases with disc involvement,and intervertebral space became narrowing at different level. Among 13 patients with kyphosis angle greater than 0°, 7 were located on thoracic, 2, 3, 1 were on thoracolumbar, lumbar and cervical spine, respectively. Among 18 cases with conservative treatment,kyphosis angle were 0° on the first and the follow up MRI of 8 patients. One case of mild (<10°) kyphosis,follow-up MRI during therapy showed the angle slightly increased; 5 cases with moderate (10° to 30°), follow-up MRI during therapy showed no obvious change; 4 cases with severe (>30°), follow-up MRI during and after therapy showed kyphosis increased in varying degrees.

CONCLUSIONFollow-up MRI can make a big difference in the spinal tuberculosis of children; it can clearly show the change of the vertebral body and intervertebral space, paraspinal abscess and the kyphosis angle after the treatment,which can provide reference for clinical treatment and estimating prognosis.

Adolescent ; Anti-Bacterial Agents ; therapeutic use ; Child ; Child, Preschool ; Drug Monitoring ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Radiography ; Retrospective Studies ; Spine ; diagnostic imaging ; Tuberculosis, Spinal ; diagnostic imaging ; drug therapy ; surgery

Objective To investigate the difference of spatial working memory among first-episode patients with deficit and nondeficit schizophrenia. Methods The study recruited 116 first-episode treatment-naive patients with schizo-phrenia, and 60 normal controls. Positive and Negative Syndrome Scale (PANSS) was used to assess symptoms of patients and Schedule for the Deficit Syndrome (SDS) was used to divide schizophrenia patients into deficit group (28 patients) and nondeficit group (88 patients). Spatial Working Memory (SWM) test from the Cambridge Neuropsychological Test Automat-ed Battery (CANTAB) was used to test the spatial working memory function. Results Adjusted for age, gender and years of education, there were significant differences in the performance of between errors of 4 boxes (P=0.03), between errors of 6 boxes (P=0.01), between errors of 8 boxes (P=0.03), total errors (P=0.01) and strategy (P<0.01) between deficit and nondef-icit patients, and both groups were poorer than the control group. The SWM of deficit and nondeficit patients has no corre-lation with the negative symptoms (P>0.05). Conclusion The impairment of SWM was more severe in deficit schizophrenia patients than in nondeficit patients at early stage of the disease, suggesting they are different subtypes of schizophrenia.

Objective To explore the prevalence and management status of asthma in downtown of Qingdao City.Method A stratified-cluster-disproportional random sampling survey was conducted with uniform procedure and questionnaire.Results The overall incidence of asthma in Qingdao City was 3.12％ (188/6026).The 2 most frequently risk factors of asthma were the allergic history and the asthma heredity (OR =3.562,2.381,P ＜ 0.05 ).In 188 diagnosed asthma patients,only 65 (34.5％)asthma patients accepted the guideline therapy,and 51 (27.1％)of them achieved well-controlled or total control.The 2 common reasons for the poor compliance were fear of adverse drug reaciion and feeling of ineffectiveness of inhaled corticosteroids.Conclusion The population in urban area of Qingdao City is suffered with high prevalence of asthma,poor compliance of guideline treatment and terrible management status.

Objective To investigate the effect of Glycyrrhizin combined with puerarin on serum Leptin and insulin resistance in non-alcoholic fatty liver disease(NAFLD) patients.Methods One hundred and twenty patients with NAFLD were randomized into 4 groups,which were control group,compound Glycyrrhizin group,puerarin group,combined group,and each group was 30 cases.Patients in control group were received the regular liver protecting therapy including vitamins,amino acids,glucurolactone,in compound Glycyrrhizin group were given 60 ml compound glycyrrhizin solution (iv),in puerarin group were given puerarin at dose of 400 mg by intravenous infusion,and in combined group were given both compound glycyrrhizin and puerarin combination.All treatment period was 4 weeks.The levels of serum serum alanine aminotransferase (ALT),aspartate aminotransferase (AST),total cholesterol (TC),triglyceride (TG),leptin (LP),fasting blood glucose (FBG) and insulin(INS) were measured,and the insulin resistance index(IRI) was calculated.The liver CT image of patients were performed by Germany Siemens dual source CT instrument.Results The levels of serum ALT,AST,TC,TG,LP and IRI in control group at before and after treatment were ((83.08 ± 115.68) U/L vs.(43.32 ±11.72) U/L,(52.12±15.62) U/Lvs.(36.08 ±7.28) U/L,(6.20±1.30) mmol/Lvs.(5.60 ±0.70) mmol/L,(2.70 ±0.50) mmol/L vs.(2.10 ±0.40) mmol/L,(14.63 ±3.26) μg/L vs.(7.61 ± 2.46) μg/L,(7.9 ± 1.8) vs.(7.0 ± 1.2)),and the difference were statistically significant (t =12.828,4.244,16.648,21.442,3.341,16.152 respectively,P ＜ 0.01).The levels of serum ALT,AST,TC,TG,LP and IRI in compound glycyrrhizin group after treatment were ((43.28 ± 11.06) U/L,(37.28 ± 7.22) U/L,(5.70± 0.80) mmol/L,(2.20 ± 0.50) mmol/L,(7.89 ± 2.26) μg/L,(7.1 ± 1.6) respectively,significant different from before treatment ((83.06 ± 14.38) U/L,(51.68 ± 15.48) U/L,(6.30 ± 1.50) mmol/L,(2.60 ± 0.40) mmol/L,(15.13 ± 3.87) μg/L,(7.8 ± 2.2) respectively,t =8.893,4.225,16.520,24.708,6.353,21.137 respectively,P ＜ 0.01).The levels of serum ALT,AST,TC,TG,LP and ISI in puerarin group after treatment were (44.26 ± 9.68) U/L,(36.86 ± 6.88) U/L,(5.60 ± 0.70) mmol/L,(2.26 ± 0.48) mmol/L,(6.89 ± 2.18) μg/L,(7.0 ± 1.8) respectively,significant different from that before treatment ((82.68±14.36) U/L,(50.06±15.23) U/L,(6.20±1.60) mmol/L,(2.70±0.52) mmol/L,(15.68 ±3.26)μg/L,(7.7 ±2.8) respectively,t =7.087,8.138,18.159,7.244,7.470,32.283 respectively,P ＜ 0.01).The levels of serum ALT,AST,TC,TG,LP and ISI in combined treatment group after treatment were (22.28 ± 9.38)U/L,(28.48 ± 9.06) U/L,(5.00 ± 0.60) mmol/L,(1.70 ± 0.40) mmol/L,(4.63 ± 2.36) μg/L,(6.20± 1.6) respectively,significantly different from that before treatment ((84.62 ± 14.88) U/L,(49.12 ± 16.56)U/L,(5.70 ± 1.60) mmol/L,(2.78 ± 0.50) mmol/L,(14.78 ± 3.68) μg/L,(7.6 ± 2.1),t =14.255,11.272,8.371,9.941,8.102,37.626,P ＜ 0.01).The levels of serum ALT,AST,TC,TG,LP and ISI of patient were no significant difference before treatment,but after treatment,these indexes in combined therapy group were the lowest among 4 groups (P ＜ 0.05).And there were no significant difference among control group,compound glycyrrhizin group,puerarin group (P ＞ 0.05).Conclusion Compound glycyrrhizin combined with puerarin is proved to be an effect treatment method for NAFLD through decreasing serum leptin,improving insulin resistance.

Objective To study the prevalence, clinical characteristics and risk factors of HIV-related lipodystrophy syndrome (HIV-LD) in our cohort of HIV-1 infected Chinese adults. Methods In a cross-sectional study, 55 HIV-infected patients were recruited from the HIV clinic of Peking Union Medical College Hospital; most of them were undergoing the first-class highly active antiretroviral therapy (HAART) of today in China. Lipoatrophy or lipohypertrophy was defined if there was concordance between the report of fat change and clinical examination of the participants. Whole body dual-energy X-ray absorptiometry (DEXA) scanning was performed. Results Prevalence of clinical body fat redistribution in the present study was 47.3%. Comparing with non-LD patients, HIV-LD patients had elder age and longer exposure to HAART(P<0.05). HAART exposure and stavudine(d4T) usage were two independent risk factors for HIV-LD. Conclusions HIV-related fat redistribution does exist in Chinese HIV population. Peripheral lipoatrophy occurs commonly in HIV-infected adults but is not associated with increased trunk fat. HAART exposure and especially d4T usage are independent risk factors for HIV-LD.

BACKGROUND: Endoscopic transnasal lacrimal duct reconstruction by grafting of autogenous tissue is a novel method for treatment of severe lacrimal duct obstruction and it needs detailed anatomical data for surgery.OBJECTIVE: To study the applied microsurgical anatomy of lacrimal duct and to provide anatomical evidence for endoscopic transnasal lacrimal duct reconstruction by grafting of autoganous tissue.DESIGN, TIME AND SETTING: This study was performed at the laboratory of the Department of Ophthalmology, Armed Police General Hospital from July 2006 to June 2007.MATERIALS: Twenty 10% formaldehyde-treated adult cadaveric heads, 14 males and 6 females, comprising 40 lacrimal ducts were included in this study.METHODS: The cadaveric heads were split on the level of the line between the superior border of the superciliary arch and the site 10 mm higher than occipital tuberosity. After removal of brain tissue,the heads were decalcified for approximate 1 week with 10%nitric acid. This promised non-alteration of morphological structure and facilitation for surgical cutting. Following dissection of facial cranium in the median sagittal plane, the nasal septum was excised to expose the lateral wall of the nasal cavity.MAIN OUTCOME MEASURES: The anteroposterior diameter and depth of lacrimal fossa; at middle third level, the thickness of lacrimal fossa at the anterior lacrimal crest, vertical middle line, and posterior lacrimal crest; the cross section area of nasolacrimal canal upper opening, middle part, and lower opening; horizontal distance, 30° oblique distance, and 45°oblique distance from lacrimal caruncie to nasal cavity; distance from lacrimal caruncle to nasolacrimal canal upper opening; and the included angle between lacrimal caruncle-nasolacrimal canal upper opening line and Aeby's plane.RESULTS: The length, anteroposterior diameter, and depth of lacrimal fossa were (17.85±1.72) mm, (6.74+1.28) mm, and (3.09+0.78) mm, respectively. At middle third level, the thickness of lacrimal fossa at the anterior lacrimal crest,perpendicular bisector, and posterior lacrimal crest was (4.03±0.89) mm, (0.61±0.36) mm, and (0.63±0.24) mm, respectively.Anterior lacrimal crest was significantly thicker than vertical middle line and posterior lacrimal crest (P ＞ 0.05). Horizontal distance, 30°oblique distance, and 45° oblique distance from lacrimal caruncle to nasal cavity was (17.23±0.70) mm,(14.51±1.72) mm, and (17.34±2.38) mm, accordingly, with a difference which was not significant (P ＞ 0.05). The distance from lacrimal caruncle to lateral wall middle point of nasolacrimal duct superior opening was (11.86±1.84) mm, and the included angle between lacrimal caruncle-lateral wall middle point of nasolacrimal duct superior opening line and Aeby's plane averaged (49.9±1.8)°.CONCLUSION: The distances from lacrimal caruncle to nasal cavity and lacrimal sac and the included angles between lacrimal caruncle-nasolacrimal canal upper opening line and Aeby's plane provide guidance significance for selection of bony opening position on the lateral wall of nasal cavity and determinations of tunnel oblique angle and autogenous tissue length. Creation of bony tunnel should start from the middle or posterior middle part of lacrimal fossa and then extend towards anterior inferior region with an optimal downward oblique angle of 45°. The length of autogenous tissue used for lacrimal duct reconstruction should exceed 21.22 mm.