Objective To investigate the effect factors and the relationship of diagnostic system efficiency as soft copy reading with medical LCD.MethodsThirty chest images were selected from PACS on-line.Three of high,mid and low-experienced radiologists interpreted the images on different types of displays independently.Design four display levels based on five factors influencing diagnostic system efficiency,including view distance (0.3 m,0.6 m,0.9 m,1.2 m),monitor resolution ( 1 MP,2 MP,3 MP,5 MP),illuminant level (50 Ix,100 Ix,200 lx,400 lx),view angle (0°,15°,30°,45°) and angle of negative effect light (0°,30°,60°,90°).Three indices of misdiagnosis frequency,diagnosis time and frequency of unable to recognize were analyzed.Orthogonal experimental design and software SPSS 13.0 were used to analyze the results.Results The indices were much different for different factors at different levels.According to the index of average misdiagnosis frequency,extreme difference value of view angle was the lowest (1.4) and angle of negative effect light was the highest (5.0).Extreme difference value of view distance,monitor resolution and illuminant level were 2.9,2.8 and 2.5,respectively.ConclusionsThe order of different factors influencing diagnostic system efficiency is as follows: angle of negative effect light,view distance,monitor resolution,illuminant level and view angle.

Objective To observe the changes of blood fentanyl concentration in rats during anhepatic phase by treatment of large dose of dexamethasone and to investigate the extrahepatic metabolism of fentanyl. Methods Thirty rats were randomly divided into 3 groups (n=10 in each group): normal control group (Group A), anhepatic phase group (Group B), anhepatic phase+dexamethasone treatment group (Group C). The hepatic portal of rats was dissociated and closed in Group B. In Group C, 20 mg/kg of dexamethasone was infused 1 h before the occlusion of hepatic portal. After intravenous injection of 20 ?g/kg fentanyl each time, the blood samples were collected. The fentanyl blood concentration was analyzed by HPLC. Results The blood fentanyl concentration of anhepatic phase dropped more slowly in Group B than Group C (P0.05). Conclusion The liver is the main organ for fentanyl metabolism. There is the extrahepatic metabolism for fentanyl and dexamethasone can enhance the extrahepatic metabolism of fentanyl.

Contraindications ; Desensitization, Immunologic ; Humans

Objective To evaluate the effects and safety of closed tracheal suction system(CTSS)versus open tracheal suction system (OTSS) for mechanically ventilated patients.Methods All randomized controlled trials (RCTs) comparing CTSS with OTSS for mechanically ventilated patients home and abroad were identified via manual and computer retrieval.All related data were extracted.Meta analysis was conducted using the statistical software RevMan 5.1 on the basis of strict quality evaluation with the methods recommended by the Cochrane Collaboration.Results Fifty-one related papers were found and 12 RCTs involving 1205 patients in CTSS group and 1179 patients in OTSS group were included.The results of meta analysis showed that CTSS was associated with a significant reduction in the duration of mechanical ventilation (WMD =-0.73,95％ CI-1.07--0.40,P＜0.0001),but the incidence of ventilator associated pneumonia and microbial colonization,mortality and length of ICU stay exhibited no difference between the two groups (P ＞ 0.05).However,compared with OTSS,CTSS reduced the incidence of arrhythmia (RR =0.23,95％ CI 0.07-0.74,P =0.01) and minimized the disturbance to heart rate (WMD =-1.97,95％ CI-3.03--0.91,P =0.0003),mean arterial pressure (WMD =-2.01,95％ CI-3.02--1.01,P ＜ 0.0001) and oxygen saturation (SpO2) (WMD =-1.00,95％ CI-1.14--0.86,P ＜ 0.000 01).Conclusions Compared with OTSS,CTSS could reduce disturbance to respiratory and circulatory system by sputum suction and shorten the duration of mechanical ventilation.However,CTSS has no advantage in prevention of ventilator associated pneumonia or microbial colonization,nor does it shorten the length of ICU stay or improve the outcome of mechanically ventilated patients.

Objective To discuss the surgical method of resection of petroclival tumors used temporal base transtentorial approach.Methods Analyzed 26 cases of petroclival tumors.All of them were surgically treated under intraoperative neurophysiological monitoring by temporal base transtentorial approach.Firstly the supratentorial part of tumors were resected by pieces,and then the tentorium was cut open,in order to resect residue of the subtentorial part of tumors.This surgical maneuver was applied to reduce the retraction to surrounding vessels,nerves and brain stem,as well to protect important structures and to finally achieve radical removal of the tumors.The efficacy and complications were observed.Results Among 26 cases,19 cases (73.1％,19/26) achieved total removal,5 cases (19.2 ％,5/26) achieved subtotal removal and 2 cases (7.7％,2/26) achieved great partial removal.There was no surgery-related death.Eleven cases suffered from partial neurological deficit.All cases were followed up for 3 months to 4 years,3 cases underwent complete recovery,4 cases underwent partial recovery,and 4 cases underwent permanent deficit.Conclusions Using temporal base transtentorial approach to resect petroclival tumors is convenient,applicable,safe and with minimal injury and with high proportionality of total resection.Under intraoperative neurophysiological monitoring,this approach may be an ideal choice for surgical treatment of these tumors.

As CD40 transduces activation signals involved in inflammatory and immune disorders, we explored the expression and response to CD40 engagement in human glioma cell lines in this study. The CD40 expression in BT-325 and U251 cells was flow cytometrically detected. The cells were incubated with srhCD40L for 72 h to assess its effects on cell growth in vitro. TNF-α expression was quantified by real-time PCR, and protein expression was analyzed by ELISA. The I-κb mRNA was detected by RT-PCR. I-κB expression decreased after stimulation with 1 μg/mL srhCD40L, but it was upregulated after the cells were pretreated with CD40 antibody. srhCD40L significantly inhibited the proliferation of the CD40+ human glioma cells. The stimulation of CD40+ glioma cells with soluble CD40L (CD154) up-regulated the expression of TNF-α at both mRNA and protein levels. We are led to conclude that CD40L/CD40 could inhibit human glioma cells through I-κb signaling pathway. Interferon-γ can augment CD40 expression and the inhibitory effect of CD40 ligand on cell growth in vitro. These results suggest that srhCD40L may benefit the therapy strategy of glioma.

Objective To systematically review the efficacy of dexmedetomidine or midazolam for sedation in critically ill patients. Methods We searched the PubMed, EMBaes, Cochrane Library, Wanfang Database,CNKI and VIP for all randomized controlled trials (RCTs) about the efficacy of dexmedetomidine versus midazolam for sedation in severe cases. The quality of the studies was evaluated by the method recommended by Cochrane Collaboration. Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.0 software. Results Six RCTs involving 613 patients were included in our Meta-analysis. The results of Meta-analysis showed that the length of ICU stay was significantly shorter in group dexmedetomidine than in group midazolam. There were no significant differences in the duration of mechanical ventilation, incidences of bradycardia, hypotension and delirium and mortality rate between the two groups. Conclusion Dexmedetomidin can shorten the length of ICU stay and is beneficial for the outcome in critically ill patients.

Objective To evaluate the effects of sedation with propofol or dexmedetomidine on volume responsiveness in critically ill patients with acute circulatory failure. Methods Ninety?one critically ill patients with acute circulatory failure, aged 20-90 yr, weighing 40-80 kg, requiring sedation with propofol or dexmedetomidine, of Acute Physiology and Chronic Health Evaluation Ⅱ scores 12-47, of Sequential Organ Failure Assessment scores 1-18, and of NYHA Ⅰ or Ⅱ, were included. The patients were randomly divided into 2 groups using a random number table: propofol group ( n = 45 ) and dexmedetomidine group ( n=46) . Before and after propofol or dexmedetomidine sedation, when Richmond Agitation Sedation Scale score reached -2 or -1 ( BIS value 60-75) ( after sedation) , passive leg?raising (PLR) test was performed to evaluate volume responsiveness. An increase in cardiac index (ΔCI) ≥10% after PLR was considered to be a positive response, whereas ΔCI<10% after PLR was considered to be a negative response. The patients who presented with negative responses before sedation served as negative volume responsiveness subgroups ( N subgroups ) , that was PN subgroup and DN subgroup. Results The positive rates of volume responsiveness were 64% ( 14 cases) and 25% ( 5 cases) in PN and DN subgroups, respectively. The positive rates of volume responsiveness were significantly higher after sedation than before sedation in PN and DN subgroups. Compared with DN subgroup, the positive rates of volume responsiveness were significantly increased after sedation in PN subgroup. Conclusion For the critically ill patients with acute circulatory failure, both propofol and dexmedetomidine sedation can improve volume responsiveness, and propofol provides better efficacy than dexmedetomidine.

Objective To observe the intervention with electroacupuncture(EA) through regulating protein kinase(MAPK/ERK) pathway for cerebral ischemia rats.Methods SD rats were randomized into pseudo-operation group,model group and EA group.And the three groups were divided into 2-hour,one-day and 3-day subgroups according to the observation time.Focal cerebral ischemia(FCI) rat models were established by middle cerebral artery occlusion(MCAO) with heat-coagulation method.EA group received EA on Baihui(GV20) and Dazhui(GV14),qd,for 2 hours,one day and 3 days respectively.The learning and memory abilities of the rats in Y maze test and their neuroethological score were observed.Immunohistochemical method was used to observe the expression of phosphorylated extracellular signal-regulated kinase(p-ERK) after ischemia in CA1 area and CA3 area.Results In the model group,the neuroethological score was markedly increased,time for arriving the safe area in Y maze was prolonged(P

OBJECTIVEThrough a simulation of interstitial fluid pressure (IFP), we developed an in vitro model to explore the change law of biological characteristics of adenoid cystic carcinoma (ACC) under different IFP.

METHODSA pressure cooker was refitted into a controllable pressure device. Cultured ACC-2 cells were subdivided into different groups, namely, negative control (untreated ACC-2) and experimental group (stressed for 3, 6, 12, 24 h under pressure of 7.551, 7.649, 7.747 kPa). CCK-8 and immunofluorescence of Ki67 were used to reflect proliferation ability. Transwell chamber assay was performed to observe the invasion ability of cells.

RESULTSThe proliferation ability was positively correlated with treatment time, and the peak value was obtained after the cells were subjected to 7.649 kPa of stress for 24 h. The invasion ability of ACC-2 cells was upregulated under stress.

CONCLUSIONWe successfully developed an in vitro model of IFP and found that high IFP can stimulate cell proliferation ability and upregulate invasion ability.