Objective To improve the diagnostic accuracy by analyzing the CT features of primary hepatic sarcoma.Methods The CT findings of 6 cases with primary hepatic sarcoma confirmed by histopathology were analyzed retrospectively,including primary hepatic angiosarcoma 2 cases,and epithelioid hemangioendothelioma,primary hepatic lymphoma,alveolar soft-part sarcoma,undif-ferentiated embryonal sarcoma,1 case each.Results Primary hepatic sarcoma appeared as multiple nodules with heterogeneous and progressive enhencement in one case,and a dominant mass with multiple satellite nodules in another case.Epithelioid hemangioendo-thelioma displayed as multifocal hepatic disease involving both liver lobes,more than half of the lesions were peripheral and extended to the liver margin.Primary hepatic lymphoma demonstrated as an ill-defined low-density lesion with irregular ring enhancement. Alveolar soft-part sarcoma presented as a well-defined low-density lesion with obviously heterogeneous enhancement in arterial phase.Undifferentiated embryonal sarcoma appeared as a huge cystic lesion with slightly margin enhancement.Conclusion The CT findings of primary hepatic sarcoma are associated with the pathological types,combining clinical symptoms with typical CT features are helpful to the diagnosis.The ultimate diagnosis relies on pathology and immune histochemistry.

This study was aimed to explore the resource diversity and microbial inhibition activity of endophytic fungi from medicinal plant Plantago asiatica L. The endophytic fungi were isolated from the root, stem and leaf of the host by tissue inoculation culture and five plant pathogenic fungi and four bacteria strains used as indicating microbes to test microbial inhibition activity by agar plate antagonistic action and modified agar gel diffusion methods. The results indicated that thirteen fungal endophytic strains were isolated from the host. Most of them came from stem, then leaf, and root as the least in number. The isolated strains attribute to five genera, two fam-ilies, and two orders based on morphological characteristics. For the isolated strains, eleven of them were found to have some microbial inhibition activities against one or more indicating fungi, making up 84.6% of the total iso-lates. Six isolated strains had some antimicrobial activities against one or more indicating bacteria, amounting to 46.2% of the total isolates. Three isolated active strains, which are PAEFS001, PAEFS007 and PAEFS008, ex-hibited evident inhibition activities against five kinds of pathogenic fungi used in the trials respectively. The strain of PAEFS001 ascribed to Ozonium sp. Both strains of PAEFS007 and PAEFS008 ascribed to Aspergillus sp. One active strain of PAEFS003 showed evident antibacterial activities to Bacillus subtilis and Staphyloccus aureus, which belonged to Fusidium sp. The endophytic fungi from medicinal plant Plantago asiatica L. have evident an-timicrobial activities. Their inhibition activities against pathogenic fungi have relatively broad spectrum. And their inhibition activities to both Bacillus subtilis and Staphyloccus aureus as G+ are evident and have certain selectivi-ty. It is feasible to find new bioactive compounds associated with endophytic fungi from Plantago asiatica L. Fur-ther research and development of the endophyic fungi will be important for the integrated utilization of the host.

Objective To compare the differences in curative effect between general treatment model and stroke unit model in the treatment of stroke in the elderly inpatients, to explore the standardized management model, for improving efficacy and reducing the degree of invalidity and mortality. Methods A total of 1200 cases with acute cerebrovascular disease were admitted into our department from April 2002 to April 2007. All patients were randomly assigned either into stroke unit or general ward to receive treatment, and the data of two groups were compared. The key indexes included mortality, hospitalization time, Barthel Index (BI), National Institutes of Health Stroke Scale (NIHSS) and Oxford Handicap Scale (OHS). All the patients or their family members were asked to have the Visual Analogue Scales (VAS). The data of cost and effect were analyzed with SPSS software. Results The complication rate and mortality rate were significantly lower in stroke unit group than in general ward group (P＜ 0.01). The scales of BI, NIHSS, OHS and VAS were significantly better in stroke unit group than in general ward group when discharged (P＜0.05). The hospitalization time was shorter in stroke unit group than in general ward group (P＜0.05). There was no significant difference in the costs of hospitalized patients between the two groups (P＞0.05).Conclusions Stroke unit model can improve the physical activity and life quality of patients and reduce disease mortality without increasing the cost of patients.

Objective To investigate perioperative nursing of respiratory system in severe scoliosis patients.Methods 26 severe scoliosis patients with respiratory function training before operation were retrospected.All of them tested pulmonary function before and after training,postoperative respiratory system nursing were also taken to maintain airway unobstructed,including respiratory rate and oxygen saturation monitoring,effective pain management and respiratory complications controlling.Results The average forced vital capacity(FVC)was 45.9%and 52.1%before and after breathing exercises,the mean forced expiratory volume in one second(FEV1)was 43.8%and 48.8%before and after breathing exercises,with lung function improvement in 69.2%patients. There were two hemopneumothorax and three mild or moderate pleural effusion occurred within 10 days after surgery,but all recovered after effective treatment and nursing.Conclusions Perioperative systematic and effective training in respiratory function and airway management can improve lung function and surgical safety,reduce the incidence of postoperative pulmonary complications,and promote early rehabilitation .

Objective To evaluate mono-and bi-exponential decay models in the diagnosis of hepatocellular carcinoma (HCC). Methods 28 patients with HCC who underwent conventional MRI imaging and diffusion-weighted imaging were collected,and all the HCC lesions were proved by operation pathology.The ADC values in mono-exponential decay model and ADCst ,ADCslow , ADCfast and ffast of the lesions in bi-exponential decay model were measured through the reconstruction of ADCmap ,ADCslow map, ADCfast map and fraction of fast ADC at a workstation.The relationships between the ADC values with low,medium and high b-val-ues and different differentiation degrees of HCC were analyzed.Moreover,the relationships between the ADCst ,ADCslow ,ADCfast , ffast values and HCC defferentiation grades were also explored.Results Significant differences in ADC value were found among differ-ent degrees of HCC differentiation in middle and high b-value groups (P <0.05).A positive correlation was found between the ADC value and the degree of HCC differentiation in middle (r=0.377,P <0.01)and high b-value group (r =0.81 5,P <0.01).There were no significant differences in ADC value among the different degrees of HCC differentiation in low b-value group.There were significant differences in the values of ADCst ,ADCslow and ADCfast among different degrees of HCC differentiation.Significant posi-tive correlations were found between the values of ADCst ,ADCslow and ADCfast and the degree of differentiation (P <0.01).There were no significant differences in the values of ffast among different degrees of HCC differentiation.Conclusion ADC value in mono-exponential decay model plays a potential role in the diagnosis of different differentiation degree of HCC with a b value ≥400 s/mm2 .Furthermore,the parameters in bi-exponential decay model,especially the values of ADCst ,ADCslow and ADCfast ,can provide new and unique information in the distinction of different degrees of HCC differentiation.

Objective: To evaluate the mechanism of T follicular helper cells ( Tfh ) in experimental autoimmune encephalomyelitis (EAE) via in vivo experiments. Methods:C57BL/6 mice were randomly divided into four groups,CFA group,EAE group,anti-ICOSL group and control group. Lymphocytes of different time points isolated from draining lymph nodes and spleen were stained for T follicular helper cells surface marker and T cells activation surface marker and analyzed by FACS. Observed parameters include inflammatory infiltration,demyelination in spinal cord and germinal center in spleen. ELISA was used to measure the level of antigen specific antibodies. Results: Mice in anti-ICOSL treated group developed mild disease was with lower clinical scores when compared with the EAE group. HE staining results turned out with alleviated inflammation and Luxol Fast Blue staining( LFB) showed no demyelization in anti-ICOSL treated mice compared with non-treated EAE models. Flow cytometry results revealed that percentages of T follicular helper cells decreased though the whole activated degree T cells was not influenced in anti-ICOSL treated group. Fewer ger minal center was found in both anti-ICOSL group and CFA group with reduced secretion of MOG-specific Ab. Conclusion:T follicular helper cells supported the development of cognate B cells,promoted the formation of germinal center,facilitate pathogenic MOG-specific Ab secretion,thus enhance EAE.

Objective To evaluate the efficacy of double filtration plasmapheresis (DFPP) in the treatment of patients with refractory rheumatoid arthritis (RA). Methods Eighty-two patients were randomly aesigned,42 to the DFPP group and 40 to the no-DFPP group. All patients previously experienced an incomplete response to 2-3 dis-ease-modifying antirheumatic drugs (DMARDs) and 1-2 nonsteroidal anti-inflammatory drugs (NSAIDs) or predni-sene. All patients received sulphasalazine (SASP,0.75 g three times daily) plus methotrexate (MTX, 10 mg orally once weekly). DFPP was performed once a week for 2-3 sessions. A total of 121 plasmapheresis procedures were per-formed in 42 patients. Control patients did not receive sham DFPP. The efficacy measures recorded one day after the final treatment and latest month in follow up for 12～24 months included the American College of Rheumatology 20% ,50% ,and 70% improvement criteria (ACR20, ACR50, and ACR70), the Health Assessment Questionnaire estimate of disability (HAQ); and the disease activity index. Results Patients in the DFPP group had ACR 20, ACR 50 and ACR 70 improvements of 100% ,92.9% and 81.0%,as compared with the patients in no-DFPP group 17.5% ,0,and 0 (P<0.001). Significant change from baseline was observed in HAQ scores in the DFPP group but not in the no-DFPP group (P<0.001). The changes from baseline in the disease activity scores were significantlygreater than in the no-DFPP group (P<0.001). Conclusion DFPP therapy significantly alters the signs and symp-toms of refractory RA. There are significant increases in physical function and improvement in quality of life.

Objective To investigate the effect of applying specialist nursing assessment indicator system on improving nurse′s health assessment ability in orthopedic department. Methods A specialist nursing assessment indicator system was developed by applying evaluation indicators of nursing care quality. That assessment indicator system consisted of 9 sub-indicators. They were assessments on local blood circulation, sensation and motion, muscle strength, pain, risk of developing pressure ulcer, risk of falling down and assessment on anal sphincter function, etc. In addition, standard assessment process was developed and applied to train 54 nurses in orthopedic department, in order to standardize and improve their ability on specialist nursing assessment. Furthermore, the assessment process was transferred into specific nursing interventions to improve nurse′s health assessment ability, too. The accurate rate on those 9 indicated assessments were evaluated and analyzed regularly, pre and post the indicator system application. In the present study, each of the 54 nurses was required to assess five patients basing on the items in the assessment indicator system. The total assessment times were 270. Results After applying the indicator system, the accurate rates of assessments on local blood circulation, sensation and motion, muscle strength, pain, risk of developing pressure ulcer, anal sphincter function and assessment on developing deep venous thrombosis were 98.89% (267/270), 99.63% (269/270), 99.26% (268/270), 97.41% (263/270), 98.15% (265/270), 91.85% (248/270), 98.15% (265/270), which were higher than 95.19%(257/270), 92.96%(251/270), 96.30%(260/270), 90.37%(244/270), 92.22%(249/270), 85.56%(231/270), 92.22%(249/270) of the time when the system was not used, and the difference was significant (χ2=5.34-16.82, P < 0.05). However, the accurate rates on assessing risk of falling down and assessing ADL were not significant different, comparing to the results before applying the indicator system (χ2=0.34, 0.41, P>0.05). Conclusions Applying the specialist nursing assessment indicator system was able to standardize nursing assessment behavior and improve nurse′s assessment ability. In addition, it was beneficial to improve the quality of specialist nursing care in orthopedic department.

Objective To explore the methods for quality management and continuous improvement of nursing care quality in the orthopedic demonstration ward by taking the hospital accreditation as an opportunity. Methods From July 2012 to June 2013, the continuous care quality improvement in the ward was carried out to find out the problems with PDCA (plan, do, check, action) cycle method, including enhancing the function of orthopedic nursing quality management groups, conducting all-staff training and improving the knowing rate by referring to the standards of hospital assessment standards. Results After the performance of whole-process quality management, the percentage of indexes assessed at level A, B and C was increased from 42.2%to 50.0%, 17.2%to 14.7%and 40.2%to 35.3%, respectively. The score of nurses' responsibility accreditation was increased from 92 to 95. The rates of patient and nursing staff satisfaction were increased from 91.8%to 98.9%and 92.57%to 97.7%, respectively. Conclusion In accordance with the standards for hospital accreditation, the continuous improvement of nursing quality in the orthopedic demonstration wards can improve the specialist care of orthopedic care, improve patients' and nurses' satisfaction, thus making the daily work more scientific and standardized.

Objective To evaluate the prostate imaging reporting and data system(PI-RADS) version 1 and version 2 for detection of prostate cancer (PCa) by multiparametric magnetic resonance imaging (MpMRI) in a consecutive cohort of patients with magnetic resonance imaging/transrectal ultrasonography (MRI-TRUS) fusion-guided biopsy.Methods 30 suspicious lesions including 15 prostate cancer and 15 non cancer at 3.0 T MpMRI were scored according to the PI-RADS V1(≥ 3 scores in at least one MRI sequence)system before MRI-TRUS fusion guided biopsy and correlated to histopathology results.PI-RADS V2 and Likert scores were determined retrospectively,diagnostic accuracy was determined using receiver operating characteristic curve analysis.Results The PI-RADS score of the dominant lesion was significantly higher in patients with PCa compared to patients with negative histopathology (PI-RADS V1:12.10±2.60 vs 7.47±1.98,P<0.05;PI-RADS V2:4.21±1.18 vs 2.79±0.92,P<0.05);Using a Likert score cut-off ≥ 4,a sensitivity of 73.7%,a specificity of 78.9%, positive predictive value of 77.74% and a negative predictive value of 75.00% (AUC=0.778,95%CI:0.63-0.93), a PI-RADS V1 cut-off ≥ 10,a sensitivity of 73.7%,a specificity of 94.7%,positive predictive value of 93.29% and a negative predictive value of 78.26% (AUC=0.911,95%CI:0.82-1.00) and PI-RADS V2 cut-off ≥ 4,a sensitivity of 57.9%, a specificity of 100%, positive predictive value of 100% and a negative predictive value of 73.37% (AUC=0.837,95%CI:0.70-0.97) were achieved.Conclusion The described fusion system is dependable and efficient for targeted MRI-TRUS fusion-guided biopsy.MpMRI PI-RADS scores combined with a novel real-time MRI-TRUS fusion system facilitate sufficient diagnosis of PCa with high sensitivity and specificity,PI-RADS scores appears to be the preferable method for the evaluation of prostate cancer than Likert score, while V2 does not perform better than V1.