Purpose To summarize the CT features and clinical characteristics of atypical primary fallopian tube cancer (PCFT) and ovarian cystadenocarcinoma (OCA), in order to improved the diagnosis. Materials and Methods CT findings and clinical data of 12 patients with atypical PCFT (PCFT group) and 20 patients with OCA (OCA group) were retrospectively studied. All patients were confirmed by pathology. Serum CA125 level, clinical characteristics and CT features of two groups were compared. Results Serum CA125 level of PCFT group and OCA group were (486.13±23.89) U/ml and (1606.94±62.86) U/ml, respectively. There was statistic difference between the two groups (P<0.01). There was significant differences on vaginal bleeding and vaginal discharge between the two groups (P<0.01). There were 4 cases with solid mass, 8 cases with cystic solid mass in PCFT group. And in OCA group, 16 cases with cystic solid mass and 4 cases with cystic mass were revealed, which showed statistic differences between the two groups (P<0.05). Some other findings also showed statistic differences including the diameter of ovarian vein on the affected side, the diameter of the round ligament of uterus on the affected side, tumor volume, and CT values of the mass in venous phase and delay phase (P<0.05 or P<0.01). However, there were no statistic significance in the size of metastatic lymph nodes, the mean CT value of the mass on plain scan and in the arterial phase (P>0.05). Conclusion Clinical findings of serum CA125 level, vaginal bleeding, and vaginal discharge combine with imaging findings of diameter of the ovarian vein in the affected side, diameter of ipsilateral round ligament of uterus, tumor volume, CT values of the mass in venous and delay phase would be the key points for differential diagnosis of PCFT and OCA.

Objective To compare the iodine contrast agent dosage,radiation dose and image quality in CT pulmonary angiogra-phy (CTPA)with low tube voltage and high tube current in 64-slice spiral CT.Methods 60 patients with suspected pulmonary em-bolism in our hospital were randomly chosen and divided into three groups:Group Ⅰ:20 patients,using 120 kV,180 mA,contrast dose of 70 mL.Group Ⅱ:20 patients,using 100 kV,280 mA,contrast dose of 50 mL.Group Ⅲ:20 patients,using 80 kV,automat-ic tube current modulation techniques (300-500 mA),comparative dose of 30 mL.CT values and image noise of three pulmonary central areas and a segment branch were measured in each group.Objective indicators,subjective image quality assessment,CT dose index volume (CTDIvol),dose-length product (DLP)and effective absorbed dose (ED)were compared in three groups to evaluate the value of low kV,high mA with low-contrast dose in CTPA.Analysis of variance and t-test was used for data analysis.Results Compared with those of the standard method of CTPA,all pulmonary dry in two groups of low dose were well displayed.There was no statistical significance between each two groups in image quality score (P > 0.05),but was statistical significance in CT values, noise,SNR and CNR (P < 0.01).The CT radiation dose,CTDIvol and DLP of Group Ⅱ and Group Ⅲ were significantly lower than those of Group Ⅰ (P < 0.01).Conclusion Compared with traditional methods,low dose contrast agent injections under 80 kV could reduce the dose of contrast agent and the effect of hardening artifacts due to contrast agent in superior vena cava on right pul-monary artery.It is helpful to reduce the risk of contrast induced nephropathy and reduce patients’exposure to X-ray radiation.

Objective To investigate the expression of Bmi-1,Mdm2 and Ki-67 in extrahepatic biliary duct carcinoma and to evaluate their clinical significance. Methods The expression of Bmi-1.Mdm2 and Ki-67 was detected in 10 normal extrahepatic biliary duct tissue and 30 cases of extrahepatic billary duct carcinoma with immunohistochemic0al staining and the their clinical significance were analyzed. Results No POsitlVe Bmi-1 expression was found in 10 normal extrahepatie biliary duct cages, while 18 of 30 extrahepatic biliary duct carcinoma cases showed positive Bim-1 expression.The expression of Bmi-I in extrahepatic biliary duct carcinoma(60.0%)was statistically higher than that in normal extrahepatie biliary duct(P<0.05).The positive expression rate of Mdm2 in extrahepatic biliary duct carcinoma was significantly higher than that in normal extrahepatic biliary duct (56.7%vs 20.0%,P<0.05).The cases of extrahepatic biliary duct carcinoma with Ki-67 proliferation index higher than 5%reached 60.0%,while the Ki-67 index was all lower than 1%in 10 normal extrahepatic biliary duct tissue, suggesting the higher proliferating activity of extrahepatic biliary duct carcinoma.No differences were found in the expressions of Bmi-1,Mdm2 and Ki-67 among extrahepatic biliary duct carcinoma cases with different clinical pathological features. Conclusion The results indicate that the expression of Bmi-1 and Mdm2 up-regulation may play an important role in carcinogenesis of extrahepatic biliary duct caroinoma. No clinical significances of the expressions of Bmi-1,Mdm2 and Ki-67 are found in extrahepatic biliary duct carcinomas.

Objective To investigate the urinary albumin excretion of the diabetes patients and application value in the monitoring of early impairment in kidney. Methods The random urine samples from diabetes patients and controls within three days were collectod. The changes of urinary albumin excretion within day and between days were analyzed. 24-hour urine albumin was used as a standard to evaluate early kidney damage. The correlations between results of random urine albumin at the different time points and different periods were comparod. The sensitivity and specificity of random urine albumin at the different time points and different periods was evaluated and compared to deduce the best diagnostic porformance of the random urine albumin. Results There are greater variations of the levels of urinary albumin of patients with diabetes and control. After the correction with urine creatinine and urine volume the variations can be reduced (CV:49%±23% and 64%±30%). Urinary albumin excretion rate change rhythmically within the 24 h in healthy and diabetes patients. We found the best correlation between overnight ratio of urinary concentrations of albumin and creatinine (ACR) and 24-hour urinary albumin (R2 = 0.976). It was superior to urina sanguinis (R~2 = 0.900), postprandial urine (R~2 = 0.584) and random urine (R~2 =0.791). When 24 h urinary albumin was taken as the standard, receiver operating characteristic (ROC) curve analysis showed there was significant difference between male and female(male 12.8 μg/mg urine creatinine vs female 27.0 μg/mg urine creatinine),and the the cut-off value of ACR was 27.7μg/mg urine creatinine. When the smallest available negative likelihood ratio (0.011) and the greatest positive likelihood ratio (481.000) were obtained,the concentration of 13.0 μg/mg creatinine and 87.4 μg/mg creatinine were set as the cut-off value of ACR. Conclusions The correction with urinary creatinine can reduce the variation between-days compared with urine volume, but still can not completely eliminate the variability. The ACR of overnight urine has the best correlation with the 24 h urinary albumin and can replace 24 h urinary albumin. Random urine as the most convenient collecting urine samples can also replace 24-hour urinary albumin, but the gender discrepancy need to be considered. When the concentration of 13.0 μg/mg and 87.4 μg/mg was set as a random ACR exclusion value and the confirmative value, it can basically rule out and confirm the existence of microalbuminuria.

Objective To investigate the effect of cartoon video-assisted preoperative interview on the postoperative maladaptive behaviors of preschool pediatric patients.Methods One hundred preschool pediatric patients,aged 3-6 yr,weighing 12-28 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective strabismus surgery,were divided into 2 groups (n =50 each) using a random number table:cartoon video-assisted preoperative interview group (group Ⅰ) and routine preoperative interview group (group Ⅱ).In group Ⅰ,accompanied by the anesthesiologist,children and their parents watched the cartoon video designed for the perioperative process,and the anesthesiologist answered the questions that their parents had.After completion of tracheal intubation,dexmedetomidine 0.3 and 0.6 μg/kg were infused intravenously over 10 min in group Ⅰ and group Ⅱ,respectively.Three percent-4％ sevoflurane was inhaled to maintain anesthesia.The development and degree of agitation during stay in the post-anesthesia care unit (PACU) were recorded.The emergence time and length of PACU stay were also recorded.Postoperative maladaptive behaviors were assessed with the Post-Hospital Behavior Questionnaire at 1 week after surgery,and the occurrence of behavioral changes was recorded.Results Compared with group Ⅱ,the incidence of emergence agitation was significantly decreased,the degree of emergence agitation was reduced,the emergence time and length of PACU stay were shortened,and the incidence of behavioral changes (4％) was decreased after surgery in group Ⅰ (P＜0.05).Conclusion Cartoon video-assisted preoperative interview can effectively decrease the development of postoperative maladaptive behaviors of the preschool pediatric patients.

Objective To investigate clinical,endoscopic and CT characteristics in Crohn's disease (CD),intestinal tuberculosis(ITB) and primary small intestinal lymphoma (PSIL).Methods In this study,39 cases of CD,24 cases of ITB and 23 cases of PSIL were retrospectively analyzed.Clinical and CT data were collected in all patients,23 CD cases,20 ITB cases and 20 PSIL cases underwent endoscopic exam.Chi-square tests or analysis of variance were used to evaluate and differentiate characteristics.Results Diarrhea,perianal disease,intestinal obstruction occurred significantly more in CD than in ITB and PSIL (x2 =10.134,6.769,8.000,P ＜ 0.05).Febrility,night sweating,pulmonary tuberculosis and ascites occurred more in ITB than in CD and PSIL (x2 =25.696,19.194,35.133,P ＜0.05).Abdominal mass,hematochezia and enterobrosis occurred more in PSIL than in CD and ITB (x2 =19.562,17.708,12.647,P＜0.05).Longitudinal ulcer,cobblestone sign were found more in CD than in ITB and PSIL(x2 =6.283,11.592,P ＜ 0.05).Transverse ulcer and rodent ulcer were found more in ITB than in CD and PSIL(x2 =15.633,19.686,P ＜ 0.05),but lump eminentia were found more in PSIL than in CD and ITB(x2 =26.120,P ＜0.05).Layering thickening,mural gas,fat,edema,enteric cavity stenosis,abscess were discovered more in CD than in ITB and PSIL (x2 =17.472,10.346,7.773,6.867,16.325,10.994,P＜0.05),single layer thickening and hollow lymph nodes were discovered more in ITB than in CD and PSIL(x2 =17.997,12.475,P ＜ 0.05).Multi segmental lesions was discovered more in CD and ITB than in PSIL (x2 =28.460,P ＜ 0.05),while single segmental lesions,mural single eccentric layer thickening and intussusceptions were discovered more in PSIL than in CD and PSIL (x2 =28.460,P ＜0.05).The intestinal wall thickening and lymph nodes enlargement in ITB and PSIL were higher than the CD (F =8.661,7.166,P ＜ 0.05),while the intestinal wall enhancement at CT imaging in PSIL was lower than CD and ITB (F =10.179,P ＜ 0.05).Conclusions Comprehensive analysis made on clinical,endoscopic and CT features of CD,ITB and PSIL may facilitate correct diagnosis.

Objective To evaluate the biological safety of 125I-filled carbon nanotubes covered with metallic esophageal stent with regard to the normal esophagus before clinical application.Methods 125I-filled carbon nanotubes covered with metallic esophageal stent was prepared.Eighteen of New Zealand rabbits were randomly divided into three groups with 6 rabbits in each group.Three groups of stents,non-radioactive,low radio-activity ( 3.7 - 5.6 MBq),and high activity ( 11.1 - 13.0 MBq ) were placed in the midpiece of esophagus of rabbits.Esophagus opacification and three-diamensions DSA were performed at 0.5 h,7,14 and 30 d after insertion of the stents,respectively.The rabbits were killed at 30d after insertion of the stents,and histologic examinations of the esophageal walls were performed.Results In non-radioactive and low activity groups,1 of 6 rabbits died of wound infection at 1 and 3 d after surgery due to pulmonary infection,respectively.All specimens were obtained from 16 rabbits.Microscopically,in all rabbits of low activity and high activity groups,there were membrana mucosa necrotic and swell and breakage of the muscle fiber in esophageal submucosa and muscularis,submucosal inflammation,which were more severe in high activity group.In low activity group,one esophagus ectal membrane was involved,however,esophageal perforation did not develop.In high activity group,3 of 6rabbits esophageal perforation had developed,in which one esophagus mediastinum fistula developed,without inflammation.In non-radioactive group,it was almost normal in mucosa layer,a small amount of inflammatory cells were found in submucosal layer,and part of muscle fibers was fractured and no pathological changes of necrosis was found.Conclusions Radioactive 125I carbon nanotubes covered metallic stent with low activity(3.7 -5.6 MBq) can be used as intraluminal palliative brachytherapy,which is safe and effective.

Objective To analyze the impact of medical insurance reimbursement mechanism on the income of urban community health centers run by various entities. Methods The data of the baseline survey of community health centers in 28 cities made in 2007 were called into play. These data were used to compare the percentage of the annual medical insurance income from outpatient clinics of three types of community health centers in their gross annual income and their annual outpatient clinic income. Results For 929 community health centers with income from medical insurance reimbursement, the average percentage of their annual income from outpatient clinic accounts for 24% of their gross annual income and 26. 09% of their annual outpatient income;In respect of the reimbursement rates of medical insurance at outpatient clinics, the highest come from those run by enterprises, secondly those by the government,and the least those run by social organizations or individuals. Conclusion The mechanism of medical insurance reimbursement has already affected the income of the third type of community health centers. It is recommended to raise the coverage rate of medical insurance of such type of centers and their reimbursement rates of medical insurance. This may further consolidate the policies of medical insurance reimbursement.

Pancreatic sarcomatoid carcinoma is an extremely rare malignant tumor.The clinical data and computed tomography images of 8 patients with pancreatic sarcomatoid carcinoma who were admitted to the Subei People's Hospital from March 2001 to January 2013 were retrospectively analyzed.The results of computed tomography showed that 8 tumors were cystic and solid,showing exophytic growth.Two tumors were located in the pancreatic head,1 in the pancratic neck,3 in the body of pancreas,and 2 in the tail of the pancreas.The shape of the tumors were round or ellipse,and the mean tumor diameter was (7.2 ± 1.8)cm (range,6.3-9.6 cm).The plain scan of computed tomography showed that the attenuation of the tumors was mild hyperdense (7 cases) or equal to pancreatic tissue (1 case).Tumors were solid with cystic components,and no hemorrhage within the tumor was detected.Small calcification nodule wasdetected in 1 case.The enhanced scan of computed tomography showed that the enhancement of the tumor was moderate; the enhancement of the tumor was higher than that of normal pancreatic parenchyma during venous phase and delayed phase,while lower than that of normal pancreatic parenchyma on arterial phase; the enhancement of tumors was significantly lower than that of aorta during all the enhanced phases.All the tumors had complete capsule,and abnormal enhancement of the capsule was not detected.Three tumors had peripancreatic lymphadenectasis,2 had infiltration of splenic artery,2 had infiltration of splenic flexure of colon and 1 had infiltration of duodenal serosa or muscle.Familiarity with the imaging features of the pancreatic sarcomatoid carcinoma can help surgeons to make a suggestive diagnosis.

Objective To explore a new method which could detect the misplacement of peripherally inserted central catheter (PICC).Methods The action of coughing was applied to 252 patients and observing the changes in dripping speed.Results The accuracy rate of this new method was 100.00％ (252/252).The success rate of first PICC in these patients was also 100.00％ (252/252).Conclusions It suggests that the new method Should be effective and convenient in the assessment of PICC misplacement and it can be applied to detect the misplacement occurred in and after the process of PICC.