Objective To explore the application value of optimal energy imaging technique of monoenergetic dual-energy computed tomography (DECT) in feeding arteries examination of rectal cancer.Methods The clinical data of 33 patients with rectal cancer who were admitted to the First Affiliated Hospital of Dalian Medical University from July 2012 to July 2014 were analyzed retrospectively.The polychromatic and monochromatic images of feeding arteries of tumors were reconstructed and evaluated using a subjective image quality score of 5-point scale by 2 observers.The consistency and scores of evaluation were analyzed by the κ test and MannWhitney U test.The CT value of feeding arteries of tumors and hip muscle,image noise and contrast to noise ratio (CNR) were measured and calculated by 2 observers,and were compared by the independent sample t test.The consistency of data between the 2 observers were measured by the intra-class correlation coefficients (ICC).Results Inferior mesenteric arteries were contributor of blood supply of tumors in all the 33 patients,including 4 cases with right inferior rectal artery as contributor of blood supply of tumors,2 cases with bilateral inferior rectal artery.Among patients with abnormal blood vessels,there were 8 patients with left colic artery and sigmoid artery having common trunk,4 patients with left colic artery originated from Inferior mesenteric artery,1 patient with absence of left colic artery.The 0-,1-,2-,3-,4-score polychromatic image quality of feeding arteries of tumors were detected in 0,13,13,5,2 patients and 0,11,14,6,2 patients by 2 observers,respectively.The 0-,1-,2-,3-,4-score monochromatic image quality of feeding arteries of tumors were detected in 0,0,7,7,19 patients and 0,0,6,9,18 patients by 2 observers,respectively.Good interobserver agreement was found for the evaluation of subjective scores (κ =0.864,0.897).The subjective scores of image quality of feeding arteries in the polychromatic images and in the monochromatic images were 1.9 ± 0.9 and 3.4 ± 0.8,with significant difference (Z =-5.21,P ＜ 0.05).The latter was superior to the former.The ICC values of the CT values of feeding arteries of tumor,hip muscle,image noise and CNR were 0.953,0.907,0.839,0.964 and 0.966,0.933,0.952,0.962 from the 2 observers,with a good consistency.The CT values of feeding arteries of tumor,gluteal muscles,image noise and CNR in the polychromatic images and in the monochromatic images were (234 ± 52)HU and (412±83)HU,(57±9)HU and (71 ±15)HU,(21 ±3)HU and (31 ±6)HU,9 ±3 and 11 ±4,respectively,with significant differences (t =-18.65,-4.44,-14.14,-6.55,P ＜ 0.05).The levels of monochromatic images of 33 patients were 51-61 keV,with a median of 55 keV.Conclusion The optimal energy imaging technique of monoenergetic DECT can improve the angiographic quality of feeding arteries in patients with rectal cancer.

A scientific appointment-driven outpatient service proves vital for the medical quality improvement initiative, and a key part of public hospital reform as well. The authors introduced the approaches taken by Northern Jiangsu People′s Hospital as follows. The hospital-wide appointment-drive service was coordinated in terms of top-level design, appointment items, appointment channels, supporting services, and monitoring regulations. This service could optimize the allocation of medical resources, enrich the connotation of appointment for registration, examination, bed, examination, operation and treatment. These efforts were expected to provide references for the implementation of overall management of the appointment-driven service of the hospital.

Objective: To compare life satisfaction and social desirability between only and non-only children in urban and rural areas, and to provide a basis for future mental health education guidance. Methods: Stratified cluster sampling method was used to select 3 765 students of grade 4 and 5 from 9 primary schools in urban and rural area of Harbin. The contents of the questionnaires included general information survey, the Multidimensional Student’s Life Satisfaction Scale (MSLSS) and the Children’s Social Desirability Scale (CSD). Results: In the overall life satisfaction, county children had the highest satisfaction (5.10±0.50), while rural children had the lowest satisfaction (4.96±0.57);The life satisfaction of girls was higher than that of boys; The life satisfaction of only children was higher than that of non-only children(F/t=17.04,-5.91,2.21,P<0.05). In terms of social desirability, the social desirability of urban children(32.33±7.04) and county children (31.78±6.30) was higher than that of rural children(30.82±6.34).The social desirability of girls was higher than that of boys, the only children was higher than that of the non-only children (P<0.05). In the overall life satisfaction and all domains of life satisfaction apart from friend life satisfaction, the life satisfaction of urban girls was higher than that of boys(P<0.05). Except for county non-only children, the social desirability of girls was higher than that of boys (P<0.05). In the overall life satisfaction and all domains of life satisfaction apart from family life satisfaction, the life satisfaction of county boys was highest among three areas (P<0.05). In all domains of life satisfaction, the life satisfaction of county girls was highest and the life satisfaction of rural girls was lowest(P<0.05). In the family life satisfaction, the life satisfaction of only boys in urban areas was higher than that of non-only boys(P=0.03). In the overall, friend, living environment and self-dimension life satisfaction, the only and non-only children in the urban, county and rural area had significant differences (P<0.05). In addition, the life satisfaction of county children was highest and the life satisfaction of rural children was lowest. The social desirability of only children in urban and county areas was higher than that of only children in rural areas. Conclusion There are differences in life satisfaction and social expectations among urban, county and rural children in Harbin. Corresponding intervention strategies should be developed when administers psychological counselling to children.

Objective: To provide a basis for college students mental health education and guidance, the impact of psychological aggression and corporal punishment college students experienced before the age of 10 on anxiety and health risk behaviors was explored. Methods: In April and May 2019, the convenience sampling method was used to conduct a questionnaire survey among all the freshman and sophomore students of some majors in two universities in Harbin, including a total of 2 150 students. The contents of the questionnaire included general information survey, Parent-Child Conflict Tactics Scale (CTSPC)，Self-Rating Anxiety Scale (SAS) and Adolescent Health related Risky Behavior Inventory (AHRBI). Results: The percentage of college students who suffered psychological aggression and corporal punishment before the age of 10 was 80.05% and 58.37%. The detection rate of corporal punishment in boys and non-only child was significantly higher than that in girls and only child (P<0.05). The students who experienced psychological aggression and corporal punishment before the age of 10 had higher detection rates of anxiety state and six subscales of health risk behaviors than those who didn t experienced those (P<0.05). The Logistic regression analysis showed that, psychological aggression, place of residence, corporal punishment, and only child were positively associated with college students anxiety state (OR=1.85,1.53,1.49,1.34). The Logistic regression analysis showed that, psychological aggression, place of residence were positively associated with college students health-compromising behaviors (OR=1.60,1.26). Psychological aggression, gender factors, corporal punishment, and only child all influenced college students aggression and violence behavior (OR=1.75,1.66,1.63,1.28). Corporal punishment influenced college students suicide and self-injury behavior (OR=3.44). Gender factors and corporal punishment all influenced college students smoking and drinking behavior (OR=2.67,2.25).Corporal punishment and psychological aggression were positively associated with college students rule breaking behavior (OR=1.88,1.55). Corporal punishment, gender factors, and family income all influenced college students unprotected sexual behavior (OR=4.51,1.91,0.62). Conclusion Parental psychological aggression and corporal punishment college students experienced during childhood have a negative impact on their anxiety and health risk behaviors.

Objective: The random forest algorithm was used to construct a rapid screening diagnostic prediction model for children with autism spectrum disorder, to provide the references for early detection, early diagnosis of ASD children, and to reduce the pressure of ASD clinical diagnosis and assessment. Methods: The random forest algorithm of machine learning was applied to build the auxiliary diagnosis model. Totally 346 ASD children and 90 normal children were evaluated by Social Responsiveness Scale and Vineland Adaptive Behavior Scales. ROC curve, and accuracy was used to evaluate the models. Results: Among the models, the accuracy of 13 feature factors and 7 feature factors were above 0.9, the sensitivity was up to 0.927, the specificity was up to 0.936 and the AUC was up to 0.979. The accuracy, sensitivity, specificity and AUC of the model were 0.943,0.959,0.931 and 0.978 respectively. The fitting and generalization effects of the three models were all satisfactory. Conclusion A random forest model based on the SRS Scales and Vineland Adaptive Behavior Scales can be used to diagnose ASD accurately and provide scientific basis for the development of rapid screening and diagnosis tools.

Objective:To investigate the influence of admission to intensive care unit (ICU ) on the postoperative complications in patients with esophageal carcinoma .Methods :A total of 391 patients with esophageal carcinoma confirmed by surgery in Department of Thoracic Surgery ,Zhongshan Hospital ,Fudan University ,from Jan 2009 to Dec 2009 ,were chosen .All the patients had clinical data and postoperative follow‐up data in detail . Patients were divided into postoperative ICU group (treatment group) and postoperative general ward group(control group) .The control group was further classified into control group A(without unplanned ICU admission) and control group B(with unplanned ICU admission) based on whether unplanned admission to ICU was conducted .The occurrence rates of postoperative complications were compared among the three groups . Logistic regression was performed in multivariate analysis of postoperative complications .Results:On Day 1 after surgery ,the APACHE Ⅱ score was higher in treatment group than in control group I(P<0 .05) .However ,there was no increase on rate of postoperative complications in treatment group .The APACHE Ⅱ score ,as well as the occurrence rate of postoperative complications ,was lower in control group A than those in control group B (P<0 .01) .The APACHE Ⅱ score in treatment group was higher than that in control group B (P< 0 .05) .However ,the occurrence rate of postoperative complications in treatment group was lower than that in control group B (P<0 .01) .On Day 1 after surgery ,the higher the postoperative acute physiology and chronic health evaluation(APACHE)Ⅱ score was ,the higher the occurrence rate of postoperative complications was(HR= 0 .631 ,95% CI:0 .405~ 0 .983 ,P< 0 .05) .Postoperative planned ICU admission could diminish postoperative complications ,and it was the independent factor(HR= 1 .588 ,95% CI:1 .147‐2 .199 ,P< 0 .01).Conclusions :If prompt admission to ICU for comprehensive treatment was conducted after esophageal cancer operation , the occurrence rate of complications could be reduced in esophageal cancer patients .

Objective:To investigate the risk factors related to intensive care unit (ICU) readmission .Methods :A total of 2491 patients who had been transferred into Department of Critical Care Medicine of Zhongshan Hospital ,Fudan University from Nov 2008 to Dec 2011 were included .Clinical data of all the patients during their first admission to ICU were collected .All the patients were classified into non‐readmission group(Group A) and readmission group(Group B) on the basis of whether there was readmission to ICU .All the patients’ treatments were conducted under supervision of attending intensivist and in accordance with routine treatment of Department of Critical Care Medicine and related clinical guidelines .Logistic regression was performed in multivariate analyses of ICU readmission .Results:If the first admission to ICU was due to emergency ,then the chance of ICU readmission was raised(HR=4 .929 ,95% CI:1 .936‐12 .549 ,P<0 .01) .If patient underwent tracheotomy during the first ICU stay ,then the chance of ICU readmission increased (HR= 3 .395 ,95% CI:1 .622‐7 .107 , P< 0 .01) . Conclusions :Both the admission to ICU under emergency and the tracheotomy during the first ICU admission are independent risk factors for ICU readmission .

Objective To evaluate the value of single-source dual-energy CT ( ssDECT ) in differentiating lipid-poor adenomas from metastases in adrenal glands .Methods From August 2011 to Oct 2014,63 patients with 73 adrenal nodules ( 53 metastases proven by 5-6 months follow-up, and 20 histopathologically proven adenomas , CT value >10 HU) underwent ssDECT scanning .The CT values of conventional polychromatic CT and virtual monochromatic images ( 40-140 keV) , fat-water density images and effective atomic number (eff-Z) were reconstructed on an ADW4.5 workstation and ROC curves were then constructed to evaluate the effectiveness of each parameter .The slope of spectral curve was measured and divided into 3 types:increment curve ( K>0.1) , straight curve (-0.1≤K≤0.1) and decrement curve ( K<-0.1) according to the slope ( the value of K ) of spectral curve , and the curve patterns in the two groups were compared statistically .Results There was no statistical difference between the mean CT values of metastases (35.12±5.29)HU and lipid-poor adenomas (32.48±6.94)HU by conventional polychromatic CT (P>0.05).The range of single-energy CT values of metastases [from (53.00±15.12) HU to (33.38± 5.67) HU] was significantly higher than that of lipid-poor adenomas [from (26.90±26.94) HU to (28.77± 10.66) HU] at energy levels ranging from 40 to 80 keV ( P<0.05).There was no significant difference between the single-energy CT value of metastases and lipid-poor adenomas at energy levels ranging from 90 to 140 keV (P>0.05).The median fat-water concentration of metastases was -164.61 μg/cm3, significantly lower than that of lipid-poor adenomas (114.32 μg/cm3, P<0.05).The eff-Z of metastases (7.76±0.15) was also significantly higher than that of lipid-poor adenomas (7.50±0.25, P<0.05).When the threshold of fat-water concentration was -143.89 μg/cm3 , the sensitivity, specificity and accuracy rate of metastasis diagnosis was 70.0%, 66.0%, and 76.7%, respectively.When the threshold of eff-Z was 7.63, the sensitivity , specificity and accuracy rate of metastasis diagnosis was 83.0%, 65.0%, and 80.4%, respectively .The lower the energy , the higher the diagnostic accuracy at energy levels ranging from 40 to 80 keV, and that of 40 keV was the highest .The spectral curves of metastases included 2 ( 3.8%) ascending curves, 9 (17.0%) straight curves and 42 (792.%) descending curves, while in the 20 lipid-poor adenomas, there were 9 ( 45.0%) ascending curves , 4 ( 20.0%) straight curves and 7 ( 35.0%) descending curves , showing significant differences between the two groups ( P<0.05) .Conclu sions Single-source dual-energy CT provides an effective multi-parameter approach for differentiating lipid-poor adrenal adenomas from metastases .

Objective To evaluate the value of single-source dual-energy CT ( ssDECT ) in differentiating lipid-poor adenomas from metastases in adrenal glands .Methods From August 2011 to Oct 2014,63 patients with 73 adrenal nodules ( 53 metastases proven by 5-6 months follow-up, and 20 histopathologically proven adenomas , CT value >10 HU) underwent ssDECT scanning .The CT values of conventional polychromatic CT and virtual monochromatic images ( 40-140 keV) , fat-water density images and effective atomic number (eff-Z) were reconstructed on an ADW4.5 workstation and ROC curves were then constructed to evaluate the effectiveness of each parameter .The slope of spectral curve was measured and divided into 3 types:increment curve ( K>0.1) , straight curve (-0.1≤K≤0.1) and decrement curve ( K<-0.1) according to the slope ( the value of K ) of spectral curve , and the curve patterns in the two groups were compared statistically .Results There was no statistical difference between the mean CT values of metastases (35.12±5.29)HU and lipid-poor adenomas (32.48±6.94)HU by conventional polychromatic CT (P>0.05).The range of single-energy CT values of metastases [from (53.00±15.12) HU to (33.38± 5.67) HU] was significantly higher than that of lipid-poor adenomas [from (26.90±26.94) HU to (28.77± 10.66) HU] at energy levels ranging from 40 to 80 keV ( P<0.05).There was no significant difference between the single-energy CT value of metastases and lipid-poor adenomas at energy levels ranging from 90 to 140 keV (P>0.05).The median fat-water concentration of metastases was -164.61 μg/cm3, significantly lower than that of lipid-poor adenomas (114.32 μg/cm3, P<0.05).The eff-Z of metastases (7.76±0.15) was also significantly higher than that of lipid-poor adenomas (7.50±0.25, P<0.05).When the threshold of fat-water concentration was -143.89 μg/cm3 , the sensitivity, specificity and accuracy rate of metastasis diagnosis was 70.0%, 66.0%, and 76.7%, respectively.When the threshold of eff-Z was 7.63, the sensitivity , specificity and accuracy rate of metastasis diagnosis was 83.0%, 65.0%, and 80.4%, respectively .The lower the energy , the higher the diagnostic accuracy at energy levels ranging from 40 to 80 keV, and that of 40 keV was the highest .The spectral curves of metastases included 2 ( 3.8%) ascending curves, 9 (17.0%) straight curves and 42 (792.%) descending curves, while in the 20 lipid-poor adenomas, there were 9 ( 45.0%) ascending curves , 4 ( 20.0%) straight curves and 7 ( 35.0%) descending curves , showing significant differences between the two groups ( P<0.05) .Conclu sions Single-source dual-energy CT provides an effective multi-parameter approach for differentiating lipid-poor adrenal adenomas from metastases .

OBJECTIVE：To systematically evaluate the effectiveness of prophylactic use of antibiotics for infection after acute stroke，and to provide evidence-based reference for clinical treatment for infection after acute stroke. METHODS ：Retrieved from PubMed，Embase，Cochrane library ，CJFD，VIP，Wanfang database and trial registration platforms such as Central ，randomized controlled trials （RCTs）about the effectiveness of prophylactic use of antibiotics （trial group ）versus placebo or non-prophylactic use of antibiotics （control group ）in the prevention of infection after acute stroke were collected during the inception to Dec. 2019. After data extraction ，the quality of included literatures were evaluated with Cochrane bias risk assessment tool 5.1.0 and modified Jadad scale. Meta-analysis was carried out by using Rev Man 5.3 statistical software. GRADE system was used to analysis the result of Meta-analysis. RESULTS ：A total of 7 RCTs were included ，involving 4 310 patients. The results of Meta-analysis showed that there was no statistical significance in the mortality of patients [RR ＝1.05，95％CI（0.92，1.20），P＝0.47] or the incidence of pneumonia [RR ＝0.92，95％CI（0.77，1.11），P＝0.40] between 2 groups. The total infection rate [RR ＝0.69，95％CI（0.57， 0.85），P＝0.000 3] and the incidence of urinary tract infection [RR ＝0.38，95％CI（0.29，0.49），P＜0.000 01] in the trial group were significantly lower than control group ，and the difference was statistically significant. Result of GRADE showed the out- comes were in high-quality grade. CONCLUSIONS ：Prophylactic use of antibiotics can reduce the total infection rate and the incidence of urinary tract infection after acute stroke ，but can not significantly affect the mortality and the incidence of pneumonia.