Objective To analyze the characteristic of auditory brainstem responses (ABR) evoked by chirp in normal hearing subjects .Methods Fifteen cases (30 ears) with normal hearing young people were recorded ABR by stimulation with two kinds of sounds :chirp and click .The data were compared .Results The response threshold of chirp-ABR were lower than that of click -ABR .The average difference was 8 .59 dB .At 90 dB nHL ,the wave V amplitude yield no significant difference between chirp -ABR and click-ABR .The wave V amplitude had a signifi-cant difference between chirp -ABR and click-ABR at 60 dB nHL .At 90 and 60 dB nHL ,the wave V amplitude of chirp-ABR had not a significant difference .The occurence rate was 40% for the wave I of chirp -ABR ,obvi-ously less than that of click -ABR .At 90 dB nHL ,the wave V latency of chirp -ABR was shorter than that of click-ABR .Conclusion The wave V response threshold of chirp -ABR is less than that of the click -ABR .The chirp-ABR is more advantageous than the click -ABR for assessing hearing threshold .

Objective To investigate the features of gallbladder carcinoma in two-phase spiral CT, and to analysis the values of two-phase spiral CT for the differential diagnosis between gallbladder carcinoma and chronic cholecystitis. Methods The two-phase spiral CT manifestations of 30 cases of gallbladder carcinoma, proved by surgery and pathology, and 30 cases of chronic cholecystitis were analyzed. Results According to the CT findings, the gallbladder carcinoma was categorized into 3 types: intraluminal mass of gallbladder in 6 out of 30 (20.0%), thickening of the gallbladder wall in 11 (33.7%), and mass replacing the normal gallbladder in 13(43.4%). The most common enhancement patterns of the wall in gallbladder carcinoma were hyperattenuation during the arterial phase, while isoattenuation with the adjacent hepatic parenchyma during the venous phase; or hyperattenuation during both phases. The most common enhancement pattern of the wall in chronic cholecystitis was isoattenuation during both phases, with clear hypoattenuation linear shadow in the gallbladder fossa. Other ancillary features of gallbladder carcinomas included: infiltration of the adjacent parenchyma, local lymphadenopathy and intrahepatic metastasis. Conclusion Two-phase spiral CT scan can identify the features of the gallbladder carcinoma and is helpful for the differential diagnosis of these two different disease entities.

Objective To evaluate the value of plain and dual-phasic enhanced 16-slice CT in the diagnosis and preoperative TNM staging of the gastric carcinoma,and to discuss the relationship between image signs and pathologic findings.Methods Fifty-three cases of the gastric carcinoma confirmed histopathologically underwent 16-slice CT examination.The scan protocol included plain scanning,the arterial phase and portal venous phase scanning.The manifestation of the three series images and multiplanar reconstruction(MPR) images were analyzed.Results ①The accuracies of 16-slice CT for the T stage,the N stage and the M stage of the gastric carcinoma were 83.02%,80.00% and 92.45% respectively.②The overall accuracy of 16-slice CT for judging TNM stage was 84.91%.Conclusion The plain scan and dual phase enhanced scans of 16-slice CT,especially the thin slice and MPR with proper windows technique are helpful for the diagnosis of gastric carcinoma and the TNM stage,which is useful for the selection of the operative project and the therapy plan.

The authors introduced,against the backdrop of the new round of accreditation,organization and practice of the hospital.In accordance with the five management elements of planning,organization,leadership,coordination and control,and the level management theory,the hospital divided,based on a top-down design and step-by-step implementation,the process into four stages of mobilization and deployment,study and training,self-assessment and rectification,supervised self-assessment and constant improvement.These efforts aim at exploring the key points and methodology of hospital accreditation,proposing such key points as the combination of the accreditation with building a long-term mechanism,that of theory with practice,that leadership with full staff involvement,that of top-down design with step-by-step implementation,that of training and rectification,that of self-assessment and supervision,and that of system management with implementation of provisions.This way the hospital accreditation may upgrade the hospital as a whole.

Objective:To observe the ultrasonographic features of cervical lymph node metastasis and analyze their relationship with the expression of cell proliferation-associated nuclear antigen (Ki-67).Methods:The clinical data of 92 patients with cervical lymph node metastasis who received treatment in Zhejiang Quhua Hospital, China between June 2017 and July 2019 were retrospectively analyzed. The correlation between ultrasonographic features of cervical lymph node metastasis and Ki-67 expression was analyzed.Results:Among the 92 patients, 158 metastatic lymph nodes were confirmed by pathological examination. The main ultrasonic imaging features were the length ratio of long diameter to short diameter < 2 in 119 (75.32%) lymph nodes, disappearance of portal hyperechoic signal in 127 (80.38%) lymph nodes, punctate hyperechoic signal in 108 (68.35%) lymph nodes, cystic degeneration in 57 (36.08%) lymph nodes, mixed types of peripheral blood flow signal in 124 (78.48%) lymph nodes, microcalcification in 123 (77.85%) lymph nodes. The length ratio of long diameter to short diameter < 2, punctate hyperechoic signal and mixed types of peripheral blood flow signal were correlated with high expression of Ki-67 ( χ2 = 24.252, 15.732, 17.033, all P < 0.05). Conclusion:High expression of Ki-67 is correlated with the length ratio of long diameter to short diameter < 2, punctate hyperechoic signal and mixed types of peripheral blood flow signal in cervical lymph node metastasis.

Objective To study the correlation between laryngopharyngeal reflux (LPR) and secretory otitis media (SOM).Methods A total of 294 adult patients with reflux-related symptoms were recruited in this study.The patients were evaluated with reflux symptom index (RSI) and reflux finding score (RFS).Tympanometry was conducted to all the patients.The 54 patients with the otitis media effusion with type B tympanograms were tested by auripuncture.Results Among the 294 patients,168 cases showed RSI＜13,in which 128 cases,31 cases and 9 cases had type A,type C,and type B tympanograms,respectively.The other 126 patients showed RSI＞13 in which 52 cases,29 cases and 45 cases had type A,type C,and type B tympanograms,respectively.Among the 294 patiems,172 patients showed RFS＜7,in which 131,32 and 9 cases had type A,type C,and type B tympanograms,respectively.The left 122 patients showed RFS＞7,in which 49,28 and 45 cases had type A,type C,and type B tympanograms,respectively.The ratio of type B tympanograms in the patients with RSI＞13 and RFS＞7 were both significantly higher than those in the patients with RSI＜13 and RFS＜7 (P＜0.05).The RSI scores of patients with type A,C,and B tympanogram were 8.6± 3.8,15.9±7.5,and 23.9±8.6,respectively,and the RFS score were 5.6±2.6,9.6±4.7,and 15.3±6.6,respectively.Compared with type A and C,the patients with type B tympanogram had significantly higher RSI and RFS score (P＜ 0.05).Among the 54 patients of type B tympanograms,those with RSI＜13 were found to have serous fluid,grume fluid,glue fluid as in 6 cases,2 cases,and 1 case,while the patient of the RSI＞ 13 had serous fluid,grume fluid,glue fluid in 13 cases,23 cases,and 9 cases,respectively.The otitis media effusion of the patients with the RSI＜13 were mainly serous,while those with the RSI＞13 were mainly sticky.Conclusion The correlation between LPR and SOM was significant.LPRmay accelerate the progress of SOM.

Objective:To investigate the effects of pre-B lymphocytic leukemia transcription factor (PBX1) expression on the apoptosis, reactive oxygen species (ROS) content and transcriptional activation factor 3 (STAT3) signaling pathway of lung cancer cells.Methods:Real-time quantitative polymerase chain reaction was used to detect the expression level of PBX1 in lung cancer tissues and adjacent tissues. The correlation between PBX1 expression level and clinical pathological parameters of patients were analyzed. Western blot was used to detect the protein expression level of PBX1 in human lung cancer cell lines, including A549, SPC-A1, SK-MES-1 and H1299. A549 cells were transfected with blank control (blank group), negative control (NC group) or PBX1 small interfering RNA (siRNA group), respectively. The cells apoptosis and ROS content were detected by flow cytometry. The protein expression levels of PBX1, STAT3, phosphorylated STAT3 (p-STAT3), B cell lymphoma/leukemia-2 (Bcl-2) and survivin in each group were detected by western blot.Results:The expression level of PBX1 mRNA in lung cancer was (2.36±0.23), significantly higher than (1.02±0.15) in paracancerous tissues ( P<0.05). The expression level of PBX1 was correlated with lung cancer differentiation, lymph node metastasis and TNM stage ( P<0.05). The expression levels of PBX1 in human lung cancer cells A549, SPC-A1, SK-MES-1 and H1299 were (0.454±0.038), (0.403±0.034), (0.311±0.028) and (0.377±0.035), respectively, significantly higher than (0.041±0.007) of human normal lung cells MRC-5 ( P<0.05). The expression level of PBX1 protein in A549 cells transfected with PBX1 siRNA was (0.082±0.010), significantly lower than (0.704±0.065) of the blank group ( P<0.05). The apoptosis rate and ROS content of siPBX1 group were (30.78±3.64)% and (51.55±5.03), respectively, significantly higher than (3.92±0.27)% and (22.36±1.31) of blank group ( P<0.05). The protein expressions of p-STAT3, Bcl-2 and survivin were (0.051±0.006), (0.202±0.018) and (0.068±0.008), respectively, significantly lower than (0.172±0.010), (0.425±0.041) and (0.196±0.021) of blank group ( P<0.05). Conclusion:Inhibition of PBX1 expression can induce the apoptosis of lung cancer cell, the mechanism may be related to ROS production and down-regulation of STAT3 signal.

Objective:To investigate the effects of pre-B lymphocytic leukemia transcription factor (PBX1) expression on the apoptosis, reactive oxygen species (ROS) content and transcriptional activation factor 3 (STAT3) signaling pathway of lung cancer cells.Methods:Real-time quantitative polymerase chain reaction was used to detect the expression level of PBX1 in lung cancer tissues and adjacent tissues. The correlation between PBX1 expression level and clinical pathological parameters of patients were analyzed. Western blot was used to detect the protein expression level of PBX1 in human lung cancer cell lines, including A549, SPC-A1, SK-MES-1 and H1299. A549 cells were transfected with blank control (blank group), negative control (NC group) or PBX1 small interfering RNA (siRNA group), respectively. The cells apoptosis and ROS content were detected by flow cytometry. The protein expression levels of PBX1, STAT3, phosphorylated STAT3 (p-STAT3), B cell lymphoma/leukemia-2 (Bcl-2) and survivin in each group were detected by western blot.Results:The expression level of PBX1 mRNA in lung cancer was (2.36±0.23), significantly higher than (1.02±0.15) in paracancerous tissues ( P<0.05). The expression level of PBX1 was correlated with lung cancer differentiation, lymph node metastasis and TNM stage ( P<0.05). The expression levels of PBX1 in human lung cancer cells A549, SPC-A1, SK-MES-1 and H1299 were (0.454±0.038), (0.403±0.034), (0.311±0.028) and (0.377±0.035), respectively, significantly higher than (0.041±0.007) of human normal lung cells MRC-5 ( P<0.05). The expression level of PBX1 protein in A549 cells transfected with PBX1 siRNA was (0.082±0.010), significantly lower than (0.704±0.065) of the blank group ( P<0.05). The apoptosis rate and ROS content of siPBX1 group were (30.78±3.64)% and (51.55±5.03), respectively, significantly higher than (3.92±0.27)% and (22.36±1.31) of blank group ( P<0.05). The protein expressions of p-STAT3, Bcl-2 and survivin were (0.051±0.006), (0.202±0.018) and (0.068±0.008), respectively, significantly lower than (0.172±0.010), (0.425±0.041) and (0.196±0.021) of blank group ( P<0.05). Conclusion:Inhibition of PBX1 expression can induce the apoptosis of lung cancer cell, the mechanism may be related to ROS production and down-regulation of STAT3 signal.

Objective: To investigate the history, risk factors for prognosis of malignant biliary stricture (MBS) patients receiving conservative therapy after endoscopic retrograde cholangiopancreatography(ERCP) and to set up a predictive model for overall survival (OS). Methods: MBS patients who underwent ERCP and conservative therapy in Xijing Hospital and PLA No.451 Hospital from January 2009 to December 2013 were enrolled to the present study. Predictive factors associated with OS were identified in the training cohort by stepwise multivariate Cox regression analysis. A predictive model was then developed and externally validated in the validation cohort. Results: Between January 2009 and December 2013, 152 and 149 patients were eligible to the training and validation cohort respectively. In the training cohort, tumors were mainly originated from bile duct (33.6%), pancreas (23.5%) or ampulla (20.4%). 76.3% (116/152) patients died during the observation period. The median OS for the training population was 5.0 months (3.9-6.2 months). CA19-9≥1 000 U/mL, non-ampulla tumor, metastasis, pre-ERCP total bilirubin≥7 mg/dL and hilar stricture were identified as independent predictive factors of poor OS (all P<0.05). Based on these factors, the COMTH predictive model was developed. The median OS of patients with COMTH>8 in the training and validation cohorts were both 3.0 months, which were significantly shorter than those with COMTH≤8 (10.0 and 6.9 months in the training and validation cohorts respectively, both P<0.001). Conclusion The prognosis of MBS patients undergoing ERCP is poor. The survival chance of patients with COMTH>8 is even more dismal.

The "student-centered" concept highlights the dominant position of students in the teaching process and makes up for the deficiency of traditional teaching mode.Based on the above idea,the teaching team of the author's department tried to improve teaching effect through effective teaching design in biochemistry.Firstly,the teaching goal (the goal of knowledge,ability and emotion) and the important situational factors the learning situation analysis,the characteristics of the course and the class,etc)should be identified.suitable teaching strategies he inspiration strategy,exploration strategy and problem solution strategy,etc.),teaching method (discussion,case study,problem based learning,etc.) and proper assessment (such as the summative assessment with formative evaluation) should be determined to organize classroom teaching.At the end of the class the timely feedback and the teaching reflection should be carried outto extend classroom teaching to extra-curricular class.The results showed that effective teaching designismore likely to stimulate students' learning enthusiasm,promote students' deep learning and achieve better teaching effects.