Objective To explore the effect of wrist extensor energy on humeral epicondylitis. Methods 48 humeral epicondylitis patients were divided into muscular energy group and block therapy group with 24 cases in each group. The muscular energy group was treated with muscle energy technique, and the other group received block therapy. They were assessed with Visual Analogue Scale (VAS) and muscle strength. They were followed up 3 months, 6 months and 1 year after discharge. Results The score of VAS was lower in the block therapy group than in the muscular energy group (P<0.01), and the muscle strength was weaker (P<0.01). 3 months after discharge, there was no significant difference in the effects between the muscular energy group (83.3%) and the block therapy group (91.7%) (P>0.05); 6 months after discharge, the muscular energy group (75.0%) was better than the block therapy group (46.1%) (P<0.01); 1 year after discharge,the muscular energy group (54.2%) was better than the block therapy group (16.7%) (P<0.01). Conclusion The block therapy is better in short-term effect on humeral epicondylitis, and the muscle energy technique was better in long-term effect.

Objective Brain metastasis of non-small cell lung cancer (NSCLC) significantly reduces the survival time of the patients, and no effective tool is yet available for the prediction of the risk.This study aimed to develop an effective and feasible nomogram for predicting brain metastasis of NSCLC after radical surgery.Methods This retrospective study included 636 cases of NSCLC treated by radical resection of the tumor in our hospitals between January 2010 and January 2014.Based on the analysis of the risk factors for brain metastasis, we developed a nomogram using logistic regression with the R-language, calculated the confidence interval (CI) of the C-index using the bootstrap, and then internally verified the overfitting degree of the model to evaluate its stability.Results Brain metastasis developed in 94 of the 636 patients.According to the results logistic regression analysis, the risk factors for brain metastasis included history of cigarette smoking (OR=1.783, 95% CI: 1.037-3.066), pathological types (OR=0.453, 95% CI: 0.275-0.744), the T stage (OR=2.047, 95% CI: 1.511-2.774), and the N stage (OR=1.588, 95% CI: 1.154-2.184).The nomogram showed a coefficient of coincidence of 0.73 (0.71-0.82) and a mean absolute error rate of 0.012, which indicated an excellent stability.Conclusion The nomogram we developed can be used to predict the risk of brain metastasis in individual NSCLC patients after surgery, contributing to follow-up programs and preventive strategies for brain metastasis.

Objective To investigate the clinical value of multi-slice CT angiography (MSCTA) of lower limbs in patients with peripheral arterial occlusive disease (PAOD) using the test-bolus technique.Methods Forty-four patients with PAOD were enrolled consecutively in the study.In group I, 18 subjects underwent CTA by bolus triggering method and in group 2, 26 subjects underwent CTA by test-bolus technique.During scanning procedure in group 2 subjects, the bolus transit time to aorta ( TAO ), popliteal arteries (Tpop ) and aorto-popliteal bolus transit time (T,) were calculated through dynamic acquisition at their respective level and the delay time were immediately set as TAO and scan time as double Tt.Two independent senior attending physicians with training experience in interpreting CTA determined the quality of each arterial segment visualization based on 5 parameters (1.visible farthest branch, 2.clarity of vessels border, 3.presence of venous contamination, 4.grading of stenosis, 5.CT value at 4 arterial segments).Inter-observer agreement on imaging quality between readers was evaluated using Cohen's k statistic by calculating K values.X2 test and t test were used to compare the quality of images in both groups.Results In group 2 patients,a larger individual variation in transit time of the contrast to reach aorta was obserued [ TAO = ( 17.1 ± 2.6) s with a range of 12.0—22.0 s ] and aorto-popliteal transit time [ Tt = ( 14.8 ± 5.5 ) s with a range of 8.0—24.0 s ].CTA of group 2 patients demonstrated bettor quality over group I patients' CTA, especifieally in the infra-pop|iteal and foot area arteries. There was an excellent inter-observer agreement for group 2 patients ( K ＞ 0.80 ) whereas in group 1 agreement in infra-popliteal segments for venous contamination ( K value 0.60 ) and stenosis degree ( K value 0.50 ) were not satisfactory enough.Group 1 patients were reported to have more severe stonosis in infra-popliteal and foot arteries( X2 = 30.55 and22.41,P＜0.01).Conclusion There was a wide interindividual variation in transit time for contrast medium to reach aorta and pollteal artery. Adaptive method by using two low-dose test bolus injection determined interindividual variation in delay time and scan time and thus above parameters was able to produce better quality images than using bolus triggering technique in below knee and foot region arteries.

Objective To explore the CT and pathological features of renal epithelioid angiomyolipoma (EAML). Methods Clinical data and CT images from ten cases with EAML proved by surgery and pathology were retrospectively analyzed. All cases were performed with plain and contrast enhanced CT scans. Results CT features: higher pre-contrasted density than kidney, bulging from kidney,absent of fat, markedly heterogeneous enhancement ( quick wash-in and slow wash-out), big size without lobular sign, complete capsule with clear margin and mild necrostic area. Pathological features: diffuse sheets of epithelioid cells were found under microscopy with immunohistochemistrical findings including positivity for HMB-45 and negativity for EMA. Conclusion Some specific CT features, which is correlated well with the pathological findings, provide helpful information in the primary diagnosis of EAML.

Objective To establish the rabbit model of radiation-induced lung injury (RILI) for the study of CT perfusion. Methods Forty-eight New Zealand rabbits were randomly divided into two groups, 36 rabbits in test group were administered with 25 Gy of single fractionated irradiation in the whole unilateral lung, and the other 12 rabbits in control group were sham-irradiated. All rabbits were sacrificed at 1, 6, 12, 24, 48, 72 h, and 1,2, 4, 8, 16, 24 week after irradiation respectively, then six specimens were extracted from upper, middle and lower fields of bilateral lungs, respectively. The pathological changes were observed with light and electron microscopies. The expression of TNF-α and TGF-β1 in local lung tissue was detected by immunohistochemistry. Results In test group, RILI occurred at early stage,characterized by acute inflammatory reaction, and featured by the progressing fibrosis at later stage. The expression of TNF-α and TGF-β1 1 and 72 h post-irradiation were statistically different between test and control groups (t = 3.04-14. 95,P ＜ 0. 05 ). Thickness of alveolar wall, density of pulmonary interstitium 12 h of post-irradiation, amount of fibroblast and fibrocyte from interstitium 24 h post-irradiation were statistically different between two groups ( t = 4.44-39. 78, P＜ 0.05 ), and correlated with the time postirradiation (r = 0. 821, 0. 872, 0. 682). There was statistical differences among the relative amount of collagen fibers at time points post-irradiation in test group ( F = 100.31, P ＜0.05), while no difference in control group ( F= 1.00, P ＜ 0.05 ). The relative amount of collagen fibers was statistically different between two groups 72 h post-irradiation (t = 3.07-45.18, P＜0.05 ), and correlated with the time postirradiation (r = 0.993 ). Conclusions Stable and reliable rabbit model of RILI could be established through single fractionated irradiation in whole unilateral lung with 25 Gy of high-energy X-rays, which may simulate the occurrence and development of evolution of RILI.

Objective To study the hemodynamic changes and pathologic foundation of rabbit models of radiation-induced lung injury (RILI) via 64-slice CT pulmonary perfusion imaging ( CTPI),in order to seek the correlation between the alterations of the hemodynamic parameters and pathophysiology.Methods Seventy-two healthy New Zealand rabbits were randomly classified into two groups:test group ( n =36),received 25 Gy with single fraction irradiation in a whole unilateral lung; control group ( n =36),received sham-irradiation.Each group was divided into 12 subgroups respectively according to post- and pseudo-irradiation time points (1,6,12,24,48,72 h and 1,2,4,8,16,24 w).Each rabbit underwent HRCT and CTPI at every pre- and post-radiation time point.All rabbits were sacrificed,and morphology of specimens was observed using light- and electron microscope. The changing regularity of HRCT,CTPI parameters and pathology were analyzed and compared with each other in order to find the correlation among them.The CTPI parameters of the test and control groups were compared using t test.The CTPI parameters and pathological values were analyzed using linear correlation with two variables,the detection rates of RILI by CTPI and HRCT was compared using Chi-square test.Results ( 1 ) The changes of CTPI parameters from control group after irradiation was relatively stable,but in test group those parameters including rBF,rBV and rPS,at pre- and post-irradiation time points (0,72 h and 2 w),were respectively 1.01 ± 0.09,1.86 ± 0.20,1.43 ±0.12,1.03 ±0.08,1.63 ±0.19,1.56±0.14,0.96±0.12,1.54 ±0.17 and 1.83 ±0.24.The corresponding parameters before and after irradiation were significantly different ( t =2.90-6.37,P ＞ 0.05).(2)In test group,capillary endothelial cells,basement membrane and alveolar epithelial cells,as the main injury targets,showed certain alterations in pathology.There was a significant correlation between the changes of CTPI parameters ( rBF and rBV) and pathophysiology in control group ( r =0.74,0.83,P ＜0.05 ),with the dependent relationship between rPS and the amounts of RBC outside the capillary and the destruction of basement membrane( r =0.87,0.88,P ＜ 0.01 ).(3)The detection rate of RILI with CTPI (72.2％,26/36) was obviously higher than that with HRCT( 16.7％,6/36,x2 =4.37,P =0.036).Conclusions CTPI parameters is capable of revealing the rule of hemodynamic process and reflecting the pathophysiologic state of different stages of RILI.By the time of detecting RILI,the detection rate of CTPI is clearly superior to that of HRCT,which yields potential value in predicting RILL

Purpose: Although obesity is associated with numerous diseases, the risks of disease may depend on metabolically healthy status. Nevertheless, it is unclear to whether metabolically healthy status affects risk of gastrointestinal (GI) cancer in general Chinese population. Materials and Methods: A total of 114,995 participants who met the criteria were included from the Kailuan Study. The study participants were divided into four groups according to body mass index (BMI)/waist circumference (WC) and metabolic status. Incident of GI cancer (esophageal cancer, gastric cancer, liver cancer, biliary cancer, pancreatic cancer, and colorectal cancer) during 2006-2020 were confirmed by review of medical records. The Cox proportional hazard regression models were used to assess the association metabolically healthy status with the risk of GI cancer by calculating the hazard ratios (HR) and 95% confidence interval (CI). Results: During a mean 13.76 years of follow-up, we documented 2,311 GI cancers. Multivariate Cox regression analysis showed that compared with the metabolically healthy normal-weight group, metabolically healthy obese (MHO) participants demonstrated an increased risk of developing GI cancer (HR, 1.54; 95% CI, 1.11 to 2.13) by BMI categories. However, such associations were not found for WC category. These associations were moderated by age, sex, and anatomical site of the tumor. Individuals with metabolic unhealthy normal-weight or metabolic unhealthy obesity phenotype also have an increased risk of GI cancer. Conclusion MHO phenotype was associated with increased risk of GI cancer. Moreover, individuals who complicated by metabolic unhealthy status have an increased risk of developing GI cancer. Hence, clinicians should consider the risk of incident GI cancer in people with abnormal metabolically healthy status and counsel them about metabolic fitness and weight control.

Objective To establish a mini pig model suitable for interventional studies in vivo. Methods The endothelia of unilateral renal arteries in 8 purebred Chinese experimental mini pigs(CEMP)was denuded by inflated balloons after the animals were fed with high cholesterol diet for 13 weeks.The CEMP were fed with h high cholesterol diet continuously till the 40th week.The levels of blood lipid panel and creatinine were tested at week 1,14 and 40.Bilateral renal arteries were examined with intravascular uhrasonography at week 14 and 40.The vessel samples were collected at week 40 and stained with haematoxylin-eosin,Masson trichrome technique, oil O and anti-macrophage immunohistological technique. Results Significant differences of blood lipid panel and creatinine were found between week 1 and week 40.Focal ischemic renal injury could be observed pathologically.Renal arteries of CEMP were suitable for interventional procedure such as angiography and intravascular ultrasonography.Cross-sectional information of vessels could be provided clearly by intravascular ultrasonography and the intimamedian thickness of injured renal arteries was much thicker than that of non-injured ones[(0.89±0.03)mm vs (0.30±0.02)mm,P＜0.05]as evidenced by this diagnostic technique.Pathological findings demonstrated the atheroselerotic profiles of the injured renal arteries.Fibrous and fibro-fatty plaques were the main pathologic types in this CEMP model. Conclusions An animal model with renal arterial atherosclerosis mimicking the progression of atheroselerotic renovaseular disease,which is suitable for interventional procedure is established successfully.Intravascular ultasonography may have potential clinical prospect on the evaluation of atherosclerotic renovaseular disease.

Purpose: The influence of fasting blood glucose (FBG) and cholesterolemia primary liver cancer (PLC) in china was analyzed via a large prospective cohort study based on a community population, and the combined effects between them were investigated. Materials and Methods: Overall, 98,936 staff from the Kailuan Group who participated in and finished physical examinations between 2006 and 2007 were included in the cohort study. Their medical information was collected and they were followed up after examination. The correlations of serum FBG or TC with PLC were analyzed. Then, we categorized all staff into four groups: normal FBG/ non-hypocholesterolemia, normal FBG/hypocholesterolemia, elevated FBGon-hypocholesterolemia, elevated FBG/hypocholesterolemia and normal FBG/ non-hypocholesterolemia was used as a control group. The combined effects of elevated FBG and hypocholesterolemia with PLC were analyzed using the Age-scale Cox proportional hazard regression model. Results: During 1,134,843.68 person*years follow up, a total of 388 PLC cases occured. We found the elevated FBG and hypocholesterolemia increases the risk for PLC, respectively. Compared with the non-hypocholesterolemiaormal FBG group, the risk of PLC was significantly increased in the non-hypocholesterolemia/elevated FBG group (HR=1.19,95%CI 0.88–1.62) and hypocholesterolemiaormal FBG group (HR=1.53,95%CI 1.19–1.97), and in the hypocholesterolemia/elevated FBG group (HR=3.16 95%CI2.13-4.69). And, a significant interaction effect was found of FBG and TC on PLC. All results were independent from the influence of liver disease. Conclusion Elevated serum FBG and hypocholesterolemia are risk factors for PLC, especially when combined. Thus, for the prevention and treatment of PLC, serum FBG and TC levels should be investigated.

Objective By analysis of the key performance indexes of the clinical laboratory automation system, to clarify the advantage and optimize the comprehensive performance of the laboratory automation system.Methods Key performance indexes were Collected from January 2017 to April 2017 in biochemistry and immunoassay group of Clinical Laboratory of Shanghai Tong Ren Hospital.(1)The data were collected and compared by the before-and-after method,the starting time of the automation system and initial sample test were analyzed.(2)Key performance indexes were analyzed for the time of specimen registration,inspection,and reporting.(3)The specimen turnaround time(TAT)was analyzed based on two months operation of the laboratory automation system.In view of disadvantage of infectious assays, setting up priority sample absorption, then TAT performance was re-evaluated.(4)By the assessment of total serum dosage required in the automation system, the number of blood vacuum tubes were reduced reasonably.The pros and cons of laboratory automation system were analyzed and the potential improvement were proposed.Results (1)According to the sample peak shift forward,the system start time could move forward 30 minutes earlier.(2)With the adopting of railway logistics,the specimens were sent to the lab and the registration time was at 7:25 am,and the time required for specimen delivery was greatly reduced which made specimen test,report and audit time all moved forward accordingly.(3)Data has shown that specimen TAT declined dramatically based on the performance of the first two month operation of the automation system,biochemical items were shortened 2 h,and the immunoassay shortened 4 h,respectively.Moreover the trend keeps better gradually.With setting up priority absorption infectious tests,the TAT was improved greatly,TAT reduced the average by 40 min.(4)500 μl(including the sample in dead space of vacuum tube)were needed for all the 65 biochemical items included in the system, and 1 495 μl serum were used for the 28 immunoassay.As a result, a total of 2 000 μl serum will be enough for sample analysis by the system, which provided the feasibility to reduce 3 vacuum tubes averagely.Considering the current automation system does not include all the analysis items in our lab directory, a few tests remain to be performed on offline instruments respectively.The methodology for some infectious agents are different from previous method, therefore some test results may need a period of time for comprehensive clinical appreciation.Furthermore,due to the parallel connection of multiple instruments included in the system, more rigorous and frequent quality control becomes a necessity,which may rely on more strict quality control procedure to guarantee the quality.Conclusions The application of the automation system significantly enhanced the efficiency of clinical laboratory all round.In addition, by the quantitative indicators, it is possible to monitor the system operation performance real time, which may feedback and facilitate the improvement constantly,and result in auto confirmation the majority results,eventually.