Stigma is demeaning,insulting social psychology mark.In A dream of red mansions,there are a lot of description about stigma and its psychological effects.Stigma effect not only influences many people's daily life,but also determines the fate of the key figures.The stigma effects also has obvious interference on the patients' psychology during the medical treatment.Moreover,stigma also influences the effects of clinical treatment.Therefore,hospitals should create an equal,united,tolerant medical environment and atmosphere of doctor-patient communication,and promote the government and the public health system to take corresponding policy measures to improve the living conditions of persons of stigma.

Objective To explore the value of dual-source dual-energy CT (DSDE-CT) in differentiating extravasation of iodine contrast agents from secondary hemorrhage after revascularization in acute ischemic stroke. Methods 46 acute ischemic stroke patients following intra-arterial thrombolysis were examined with DSDE-CT within 2 hours after the procedure. Simultaneous imaging at 80 kV/392 mA and 140 kV/196 mA was employed, and then mixed images, virtual unenhanced non-contrast images and iodine overlay maps were calculated. Mixed images alone, as conventional CT, and DUDE-CT interpretations were assessed separately by two radiologists and compared with follow-up CT. Results 6 of 34 patients were negative cases proven by CT without high density, and another 28 cases were proven positive cases with 3 cases of cerebral hemorrhage, 21 cases of contrast agent extravasation, and the remaining 4 cases of combined cerebral hemorrhage and contrast agent extravasation. The sensibility, specificity, positive predictive value, negative predictive value and accuracy of mixed imaging alone in diagnosing hemorrhage was 66.67%, 100%, 1005, 96.15% and 96.43%, while the sensibility, specificity, positive predictive value, negative predictive value and accuracy of hemorrhage with DUDE-CT was 100%, 96%, 75%, 100% and 96.43% . The diagnostic accuracy of superimposed fusion images for intracranial hemorrhage, extravasation of contrast agent and hemorrhage with extravasation of contrast agent was relatively high, and the difference was statistically significant (P < 0.05). The diagnostic accuracy of superimposed fusion images consistent with clinical follow-up was significantly higher (Kappa=0.815),as compared with that of mixed imaging alone (Kappa=0.0.564). Conclusion DUDE-CT has great value in differentiating hemorrhage from iodinated contrast after intra-arterial thrombolysis in acute ischemic stroke.

Objective To study the presentation,sensitivity of different diagnostic methods,snrgical modalities and pathological findings for patients of substemal goiter. Methods The clinical data of fifty nine cases of substernal goiter surgically treated were retrospectively analyzed. Results The main symptoms of substernal goiter patients were asymptomatic cervical mass(39/59),airway obstruction (13/59),hyperthyroidism(4/59),hoarseness(3/59)and choke(3/59).The sensitivity of chest X-ray,ultrasonography,CT and scintigraphy was 62.8%,15.8%,85.7%,and 50.0%respectively,and the specificity Was 99.4%,99.8%,99.5%and 99.0%,respectively.Standard cervical approach was successful for thyroidectomy operations in 57 cases.One patient underwent thyroidectomy by sternotomic approach,and another one by combined cervici-sternotomic approach.No major complications or perioperative deaths occurred.Pathology revealed nodular goiter in 48 cases.Grave's disease in one,thyroid adenoma in 2,and carcinoma in 8. Conclusions CT and chest X-ray are sensitive diagnostic techniques for substerual goiter.Cervical approach is appropriate for most substernal goiter.

Objective To determine the utility of apparent diffusion coefficient (ADC) values as an objective method of early detection of traumatic brain injury of the mice models in hippocampus injury.Methods A total of 18 healthy male adult C57/BL6 mice were randomly divided into three groups according to the degree of injury:the mild group,severe group and control group.Conventional images,diffusion-weighted images,ADC were studied.The hippocampal were selected as the interesting area.ADC values were calculated and compared with those in control subjects after 6 h,12 h and 24 h.Student t test was performed for each region to compare the injury groups and the control.Results In control group both sides hippocampal ADC values had no differences(8.65±0.26 and 8.77±0.12) × 10-4 mm2/s,P＞0.05.Abnormalities were detected on ADC values,compared with conventional images in the injury groups.ADC values in mild group and severe group were significantly different from those of control group(6 h ADC values were (8.70±0.50) × 10-4 mm2/s,(6.13± 0.11) × 10-4 mm2/s,and (3.16±0.78) × 10-4 mm2/s in control,mild and severe group respectively),(12 h ADC values (8.23±0.61)× 10-4 mm2/s,(5.92 ± 0.27) × 10-4 mm2/s and (2.64±0.65) × 10-4 mm2/s) and (24 h ADC values (9.01±0.14) × 10-4 mm2/s,(5.99± 0.13)×10-4 mm2/s and (2.58±0.42)×10-4 mm2/s),P＜0.05.Conclusion There are differences among the ADC values on differcnt types of hippocampal brain injury mouse-model.ADC values can identify the degree of damage on brain injury and can detect early craniocerebral injury.

Objective To evaluate and improve the geometrical accuracy of the magnetic resonance imaging used for gamma knife radiosurgery localization. Methods Four common MRI scan programs were used in this study. The images were transferred to the Gamma Plan treatment planning system.Deviations between stereotactic coordinates based on MR images and real geometrical positions given by the construction of the phantom insert were evaluated for each study.The deviations were further investigated as a function of the spatial position of measured points in the investigated volume.Results The geometrical coordinate errors for axial and coronal images of the selected scan programs were all less than 1 mm.Optimal imaging procedure in terms of geometrical accuracy was observed using spin echo T1 and 3D FSPGR MRI sequences in the unit.Statistically significant differences were found in axial images amongSE T1,FSE T2,FRFSE Pd,FSPGR 3D sequences (F=1497.51,1873.63,2.87,3.00,P ＜0.05).The error increased along with the increase of the distance between node point and centricity.Conclusions The geometrical coordinate errors is related with the imaging program in M(il)l. Proper imaging programs and parameters should be selected according to the imageology character of patients' lesions when the radiosurgery is performed.

Objective To evaluate the influence of the CT enterography (CTE) in different scan phases of small intesti?nal wall and arteriovenous vessels, and to confirm the diagnostic efficiency thereof. Methods A total of 286 patients under?went CTE were collected, and their CT image of three scan phases, including 20 s, 40 s and 60 s after injection, were record?ed. Values of reinforcement of the intestinal wall and arteriovenous enhancing degree in all phases were collected. A statisti?cal analysis was used to confirm the best phase for showing the structure. The diagnostic efficiency of the best phase of CT image was evaluated for the clinical diagnosis of small intestine and vascular lesions. Results (1) The CT value of the small intestinal wall in the intestinal phase was significantly higher than other two phases (P<0.05). There was no significant dif?ference in CT value between arterial phase and portal phase. (2) Comparison between three phases of CT values of ileum showed that artery:arterial phase>intestinal phase, and there is no statistical difference between the intestinal phase and oth?er two phases. The result of CT value of ileum vein showed that intestinal phase>portal phase>arterial phase (P<0.05). (3) The sensitivity was 95.8%, the specificity was 94.9%, the accuracy was 95.1%, the positive predictive value was 79.3%and the negative predictive value was 99.1%using CT image of intestinal period for diagnosing small intestinal diseases. (4) The intestinal period showed small intestinal lesions and confirmed by pathology including 22 cases of small intestinal lympho?ma, 10 cases of stromal tumor, 1 case adenoma, cavernous 3 cases hemangioma and 8 cases of Crohn's disease. The diagno?sis of hemangioma should be combined with arterial phase. Conclusion Small intestinal wall and blood vessels have better display performance in the intestinal phase of multiphase CT enterography, using the arterial phase and intestinal phase scan?ning, we can make an accurate diagnosis for the majority of small intestinal diseases.

Objective:To screen the time points of high survival rate and efferocytosis dysfunction of rat alveolar macrophages stimulated by cigarette smoke extract (CSE), establish an in vitro model of alveolar macrophage efferocytosis function, and study chronic respiratory diseases with chronic inflammatory reaction as the main pathological changes. Methods:① Time point screening experiment: rat alveolar macrophages (NR8383 cells) were cultured in vitro, and the cells in logarithmic growth phase were divided into blank control group (100 μL complete medium) and 5% CSE group (90 μL complete medium + 10 μL 100% CSE). Alma blue method was used to detect the effect of 5% CSE on the activity of NR8383 cells at 6, 12, 24 and 48 hours. ② Apoptosis induction experiment: rat type Ⅱ alveolar epithelial cells (RLE-6TN cells) were cultured in vitro as phagocytic target cells of NR8383 cells, and the cells in logarithmic growth phase were divided into blank control group and 10, 30 and 60 minutes groups after ultraviolet exposure (apoptosis was induced by 30 000 μJ/cm 2 ultraviolet irradiation for 15 minutes). Flow cytometry was used to detect the apoptosis rate of RLE-6TN cells cultured for 10, 30 and 60 minutes after ultraviolet exposure. ③ Cell efferocytosis experiment: NR8383 cells in logarithmic phase were divided into blank control group and 5% CSE group. Two hours before NR8383 cells were stimulated by CSE for 6, 12 and 24 hours, RLE-6TN cells were exposed to ultraviolet to induce apoptosis, and the RLE-6TN cell suspension was added to NR8383 cells (the ratio of RLE-6TN cells to NR8383 cells was 5∶1). Flow cytometry was used to detect the efferocytosis rate of NR8383 cells to RLE-6TN cells at different time points treated with 5% CSE. Results:① Compared with the blank control group, the activity of NR8383 cells significantly decreased after treatment with 5% CSE for 48 hours [cell reduction rate: (68.5±4.1)% vs. (73.6±2.3)%, P < 0.05]. However, there were no significant differences when the activities of NR8383 cells treated with 5% CSE for 6, 12 and 24 hours were compared with the blank control group, so these three time points were selected for the subsequent establishment of alveolar macrophage cell efferocytosis dysfunction in vitro model experiment. ② Compared with the blank control group, the apoptosis rate of RLE-6TN cells significantly increased at 10, 30 and 60 minutes after ultraviolet exposure [(66.87±8.63)%, (85.51±2.39)%, (96.13±2.74)% vs. (9.13±3.17)%, all P < 0.01] in a time-dependent manner. Considering that it taked about 50 minutes for RLE-6TN cells to be labeled with PKH26 membrane labeling probe, 10 minutes after ultraviolet exposure was selected to label RLE-6TN cells. ③ Compared with the blank control group, the efferocytosis function of NR8383 cells was significantly decreased after treatment with 5% CSE for 12 hours [cell efferocytosis rate: (33.64±1.30)% vs. (44.02±2.71)%, P < 0.01], but there was no significant effect on the efferocytosis function of NR8383 cells at 6 hours and 24 hours. Conclusions:CSE can induce alveolar macrophage cell efferocytosis dysfunction. Based on the test results of the effect of 5% CSE on NR8383 cell activity and cell efferocytosis function, 12 hours with high survival rate and weak efferocytosis effect of NR8383 cells can be selected as the in vitro model condition of alveolar macrophage cell efferocytosis dysfunction.

Objective To evaluate the efficacy of lumbar discectomy,radiofrequency ablation and annuloplusty performed with Disc-FX system under the guidance of C-arm in treatment of discogenic low back pain.Methods Twenty-eight patients with discogenic low back pain,with VAS score greater than 7,aged 27-73 yr,underwent lumbar discectomy,radiofrequency ablation and annuloplusty performed using Disc-FX system under the guidance of C-arm.The patients were followed up for 2 months after surgery and pain was assessed using VAS score.VAS scores were recorded before surgery,and at 7 and 14 days and 1 and 2 months after surgery.The effective analgesia was recorded according to VAS scores.The therapeutic effect was evaluated according to Macnab standard 2 months after surgery.Results VAS scores were significantly lower at each time point after surgery than before surgery (P ＜ 0.05).The rate of effective analgesia was 93 % at 2 months after surgery.The excellent and good rate of the therapeutic effect evaluated was 93 %.One female patient developed injury to lumbar venous plexus,and no patients developed infection of intervertebral disk,nerve root injury or spinal cord injury.Conclusion The excellent and good rate is 93 % when lumbar discectomy,radiofrequency ablation and annuloplusty performed using Disc-FX system is used for treatment of discogenic low back pain under the guidance of C-arm,with fewer side effects.

Objective To evaluate the impact of sarpogrelate on the in-stent restenosis (ISR) after percutaneous transluminal angioplasty (PTA) in peripheral arterial diseases (PAD).Methods PAD patients who had PTA for the first time were divided into two groups receiving respectively clopidogrel and aspirin (clopidogrel group) or sarpogrelate and aspirin (sarpogrelate group).Vascular ultrasonography was performed at 6 months after PTA in all patients to evaluate the degree of ISR.Results 62 patients finished the follow-up visits as required.The in-stent restenosis in the sarpogrelate group and clopidogrel group was 7.0％ vs.18.1％ (P =0.036),the peak systolic velocity ratio was 1.34 vs.2.08 (P =0.010) and the cases of ISR was 1 vs.10 (P =0.005) respectively.No patients reported serious adverse events.Conclusions Sarpogrelate combined with aspirin is safe and effective.Compare with clopidogrel and aspirin,sarpogrelate and aspirin can significantly reduce the rate of ISR after PTA and the intimal proliferation in the stent.

As one of the top three causes of death in the world, chronic obstructive pulmonary disease (COPD) is a serious hazard to human health. Macrophages play an important role in COPD, and their efferocytosis function is essential for ending chronic inflammation of COPD. Efferocytosis damage of alveolar macrophages (AM) in patients with COPD causes the rising of bacterial infection and airway bacterial colonization risk in lungs, which is the main reason for the acute exacerbation and the rising of incidence rate and mortality rate in COPD. In recent years, the regulation of macrophage efferocytosis function in COPD has becoming a research hotspot. Progress on the role of macrophage efferocytosis function on COPD, and the breakthrough points of improving AM efferocytosis dysfunction by traditional Chinese medicine is reviewed, so as to provide new ideas for the prevention and treatment of COPD.