Objective To evaluate the efficiency of dexmedetomidine combined with flurbipro-fen axetil preventing agitation and reducing extubation reaction after general anesthesia. Methods Eighty patients,ASA Ⅰ or Ⅱ,scheduled for selective oral and maxillofacial surgery were randomly divided into four groups,20 patients in each group.30 mins before end of the operation, patients intravenously received flurbiprofen axetil 50 mg (group F),dexmedetomidine 0.5 μg/kg (group D),dexmedetomidine 0.25 μg/kg plus flurbiprofen axetil 50 mg (group DF),normal saline (group C),respectively.MAP,HR were recorded before extubation (T0 ),extubation (T1 ),5 mins after extubation (T2 ).The recovery time,extubation time,Riker sedation-agitation score(RSAS)be-fore extubation and Ramsay sedation score 5 min after extubation were observed.Results Compared with T0 ,MAP,HR at T1 ,T2 in group C and group F were significantly increased (P <0.05 or P <0.01),MAP,HR at T1 ,T2 in group D and group DF were significantly lower than those in group C (P <0.01 ).The recovery time,extubation time in group D were significantly longer than those in group C,group F and group DF(P <0.05).Ramsay scores in group D was significantly higher than other groups(P <0.05).The incidence of agitation in group D and group DF were significantly lower than those in group C(P <0.05 or P <0.01).Conclusion Dexmedetomidine 0.25 μg/kg plus flurbi-profen axetil 50 mg can effectively prevent agitation and reduce extubation cardiovascular reaction dur-ing recovery period,without the disadvantage of prolonging the recovery and extubation time.

Objective To analyze features and diagnostic value of imageology of the early peripheral lung carcinoma.Methods The dynamic changes of early peripheral lung carcinoma confirmed pathologically in 21 cases were retrospectively analysed.The imaging features in combination with pathological data were also analysed.Results All of 21 cases,16 cases were the tubercle type(76.1%),3 cases were the spot type(14.3%) and 2 cases were the vacuole type(9.6%).Conclusion The typical imaging features of early peripheral lung carcinoma are few,the dynamic observation of the disease is of relatively high value in diagnosis.

Objective To explore the incidence of early complications within 72 hours among patients with six kinds of acute organophosphorus pesticide poisoning,thus to provide reference for the clinical treatment.Methods The retrospective study analyzed the clinical data of 335 cases with acute oral organophosphorus pesticide poisoning treated in Emergency Department of 307 Hospital of PLA from July 2008 to December 2015.Patients were divided into six groups according to the results of serum toxicology tests:acute phorate group (group A),acute dichlorvos group (group B),acute omethoate group (group C),acute dimethoate group (group D),acute phoxim group (group E) and acute parathion group (group F).The incidence of complications among the six groups were compared.The main analysis method was ranks test.Results There were no significant differences among the six groups in the incidence of cerebral edema,liver injury,kidney injury,myocardial injury,gastrointestinal hemorrhage and acute pancreatitis (P ＞ 0.05),while the mortality and the incidence of sudden cardiac arrest (SCA),respiratory failure,circulatory failure,multiple organ dysfunction syndrome (MODS),coagulation disorders and capillary leak syndrome (CLS) were significantly different among the six groups (P ＜ 0.05).The incidence of SCA wihin 24 hours in acutedichlorvos group reached up to 17.8％,and in other groups was as follows:acute parathion group (11.1％),acute dimethoate group (8.9％),acute phorate group (7.8％) and acute omethoategroup (1.5％).However,no one developed SCA in acute phoxim group.The total incidence of circulatory failure in all patients was 10.1％;dichlorvos group 31.1％ and dimethoate group (22.2％) had higher rates than other groups.The incidence of respiratory failure in all groups reached over 20％,while the total incidence was 36.7％,whereby,acute phorate group with a high of 46.7％,acute dichlorvos group with 44.4％,acute parathion group with 44.4％ and acute dimethoate group with 42.2％,respectively.The total incidence of coagulation disorders was 9.6％,while the incidences of the acute dichlorvos group (24.4％),acute phorate group (11.6％) and acute parathion group (11.1％) were higher than 10％.CLS confined to occur in acute dichlorvos group (11.1％) and acute phorate group (2.5％).However,MODS occurred mainly in acute dichlorvos group (28.9％) and acute parathion group (22.2％).Conclusions The incidences of early complications among the six groups are different,while acute oral dichlorvos poisoning patients tend to occur SCA.Within 72 h of poisoning,acute phorate poisoning group is more prone to respiratory failure,and acute dichlorvos poisoning group is more likely to develop coagulopathy disorders,circulation failure,CLS and MODS.Those patients in acute omethoate and acute phoxim poisoning groups have less risk to develop life-threatening complications except respiratory failure.

Objective To analyze the characteristics and to evaluate the application of quantitative CT spectral parameters in patients with suspected lung cancer.Methods One hundred and thirty two patients with occupying lesions of the lung underwent chest plain and two-phase contrast enhanced CT scan with gemstone spectral imaging (GSI) mode.The CT images of patients with confirmed lung cancer by pathological evidence were analyzed with GSI viewer.Optimal energy value supplying optimal contrast-tonoise ratio (CNR) was recorded.The CT values of lesions at 40 keV,70 keY and optimal energy level were measured.Spectral curve slope at different intervals of 40-70 keV,40-100 keV and 40-140 keV was computed.Effective atomic number (Zeff),iodine concentration (IC) and water concentration (WC) were measured and analyzed by statistical methods.Results Sixty six patients with confirmed lung cancer were included in the analysis.The optimal energy values for optimal CNR on plain scan,arterial phase and venous phase were (63.09±5.33) keV,(52.65±6.44) keV and (54.06±5.53) keV,respectively.The difference of CT values at different energy levels on each scan phase was statistically significant (F=4.561,P=0.025).The spectral curve slope values among three different energy intervals were significantly different (F=2.137,P＜0.001).The differences of the slope between arterial phase and venous phase at same energy interval were not significant (40-70 keY:t=1.165,P=0.248;40-100 keV:t=1.102,P=0.274;40-140 keV:t=1.118,P=0.268).Zeff on plain scan,arterial phase and venous phase was 7.73±0.14,8.35±0.37 and 8.39±0.30,respectively.There was positive correlation between IC and Zeff on enhanced phase (arterial phase:r=0.998,P＜0.001;venous phase:r=0.998,P＜0.001).Conclusion CT spectral imaging can supply the optimal energy value for optimal CNR.CT value at optimal energy level and spectral curve slope at 40-140 keV are suitable for analysis.IC and Zeff can be used jointly in evaluation of patients with suspected lung cancer.

Objective To compare the image quality of chest low dose CT (LDCT) using automatic exposure control (AEC) and constant current control (CCC) and explore a more reasonable scanning protocol. Methods Two hundred and eighty participants were examined with 64 CT scanner at 7 centers in China. All were divided into 4 groups. Two groups underwent LDCT using AEC with standard deviation set at 25 (A1) and 30 (A2) respectively and the tube current ranged from 10 mA to 80 mA. The other two groups underwent LDCT using CCC with tube current set at 40 mA (C1) and 50 mA (C2) respectively. The axial and MPR images were evaluated by two radiologists who were blinded to the scanning protocols.The radiation dose, noise and the image quality of the 4 groups were compared and analyzed statistically.Differences of radiation dose and noise among groups were determined with variance analysis and t test,image quality with Mann-Whitney test and the consistency of diagnosis with Kappa test. Results There was a significant lower DLP in AEC group than in CCC group [(82.62±40.31)vs ( 110.81±18.21) mGy·cm (F =56. 88 ,P ＜ 0. 01 )], whereas no significant difference was observed between group A2 and group A1 0. 05]. The noisy of AEC group was higher than that of CCC group both on lung window(41.50±9.58 vs 40.86±7.03) and mediastinum window (41.19±7.83 vs 40.92±9.89), but there was no significant difference( Flung =0.835, P=0.476, Fmediastinum =1.910, P=0.128).The quality score of axial image in AEC group was higher than that in CCC group (superior margin of the brachiocephalic vein level: 4.49±0.56 vs4.38±0.64,superior margin of the aortic arch: 4.86±0.23 vs 4.81±0.32,the right superior lobar bronchus Level:4.87±0.27 vs 4. 84 ± 0. 22, the right middle lobar bronchus Level: 4.90±0.25 vs 4.88±0.21) except on the right inferior pulmonary vein level(4. 92 ±0. 25 vs 4. 93 ±0. 17) and superior margin of the left diaphragmatic dome level (4. 91±0.27 vs 4.93±0.22) on lung window, but no significant differences (F=0.076-1.748, P＞0.05) were observed. A significant higher score in AEC group was observed on mediastinum window compared with CCC group on superior margin of brachiocephalic vein level (2.57±0.77 vs 2. 46 ± 0. 59, F = 8. 459, P ＜ 0. 05 ), however, the score of AEC group was lower than that of CCC group on other levels without significant differences (superior margin of the aortic arch:3.36 ±0. 63 vs 3.45 ±0. 60,the right superior lobar bronchus level: 3.94 ±0. 56 vs 3. 95 ±0. 51 ,the right middle lobar bronchus Level: 3.80 ±0. 58 vs 3. 87 ±0. 50,the right inferior pulmonary vein level: 3.72 ±0. 56 vs 3.78 ±0. 53, superior margin of the left diaphragmatic dome level: 3.58 ± 0.63 vs 3.68±0.56,F=0.083-3.380,P ＞ 0.05 ). The MPR image quality of AEC group was better than that of CCC group both on lung window and mediastinum window (Zlung =-2.258, Zmedlastinum=-1.330, P＞0.05). For all participants including the underweighted group, the normal group and the overweighted group, the image quality of A1 group was better than that of A2 group without significant differences (the underweighted group: Zlung=0.000, P=1.000, Zmedastinum= 0.000, P=1.000;the normal group: Zlung =-0.062, P=0.950, Zmediastinum =-0.746, P = 0.456; the overweighted group: Zlung = - 1.177, P = 0.239,Zmediastinum =-1.715, P=0.144) both on lung and mediastinum windows, and for the higher BMI participants, a better image quality was obtained in A1 group than in A2 group on the mediastinum window (Z = -1. 715, P = 0. 144). Conclusions The total radiation exposure dose of AEC group is significantly lower than that of CCC group, but no statistical significant differences are observed between both groups in image quality and noise level. The AEC technique is highly recommended in thoracic LDCT scan for screening program, and the SD25 ( SD value = 25) scan protocol is suggested for higher BMI population while the SD30 (SD value = 30) scan protocol for lower BMI population.