Objective To investigate the advantage of separate bolus injection technique in CT urography (CTU) improving the display of the whole urinary tract.Methods Sixty cases of CTU examination,were divided into observation group and control group by random digits table with 30 cases each,observation group used separate bolus injection technique and control group used single bolus injection technique.The scanning included routine scanning,cortical phase,medullary phase and lag phase.Reconstruction of lag phase displayed the whole urinary tract.Then the image quality was compared between two groups.Results The whole urinary tract showed excellent in 12 cases (40.0％,12/30),good in 17 cases (56.7％,17/30),normal in 1 case (3.3％,1/30) in control group,which showed excellent in 23 cases (76.7％,23/30),good in 7 cases (23.3％,7/30) in observation group,there was significant difference in excellent rate between two groups (P ＜ 0.01).The CT value of starting of ureter was (238.6 ± 82.5) HU,middle-lower ureter was (245.9 ± 112.3) HU in control group and (239.0 ± 93.8),(235.3 ± 74.6) HU in observation group,there was no significant difference between two groups (P ＞0.05).There was no difference in developing of urolithiasis between two bolus injection techniques.Conclusion The application of separate bolus injection technique in CTU examination can reduce the dose of the first contrast material and contrast material reaction,and receive high-quality image of the whole urinary tract.

Objective In this study,we aim to evaluate the risk and incidence of traumatic cervical spinal cord injury (CSCI) in patients with traumatic cervical spinal canal stenosis (CSCS) without major fracture or dislocation,and evaluate the feasibility of preventive decompression surgery. Methods This study included eighty?seven patients with traumatic CSCI without major fracture or dislocation treated in our department between 2005 and 2012. Mann?Whitney U test was used for statistical analyses. Analysis of variance (ANOVA) was used to calculate the relative and absolute risks for the incidence of traumatic CSCI without major fracture or dislocation related with CSCS. Results The relative risk for the incidence of traumatic CSCI with CSCS was 145.7 times higher than that for the incidence without CSCS. However ,only 0.000026% of patients with CSCS may be able to avoid developing traumatic CSCI if they underwent decompression surgery before trauma. Conclusions Prophylactic surgical management for CSCS might not significantly affect the incidence of traumatic CSCI.

Objective To explore the relationship between the expression of basic fibroblast growth factor (bFGF) and microvessel density(MVD)in non-small cell lung cancer.Methods The expression of bFGF and MVD were observed in 54 eases of NSCLC were detected with in situ hybrldization and immunohistochemical detection.Resuits The expression of bFGF and MVD was greater in adenecarcinomas than in squamous cell carcinomas of NSCLC (P＜0.05).The expression of bFGF was significantly different among the three groups of both squamous cell carcinomas and adenocarecnomas with varying differentiation (P＜0.05).There was hisher bFGF expression and greater MVD in NSCLC patients with regional lymplmode involvement and those with laterdistant metastasis(P＜0.05).Condusion bFGF may play an important role in tumor angiogenesis and lymphatic metastasis of human NSCLC,and detection of bFGF may be a good metastasis and prognostic predictors for human NSCLC.

Animals ; Cytokines ; blood ; Endotoxemia ; blood ; therapy ; Endotoxins ; blood ; toxicity ; Enzyme-Linked Immunosorbent Assay ; Hemofiltration ; Interleukin-1 ; blood ; Interleukin-10 ; blood ; Models, Animal ; Swine ; Time Factors ; Tumor Necrosis Factor-alpha ; analysis

Objective To evaluate the clinical outcome of one-level posterior lumbar interbody fusion (PLIF) performed with microendoscopic approach.Methods A consecutive series of 56 patients who under went one-level PLIF procedure(24 cases performed with microendoseopic approach and 32 cases with tradition- al open approach)were studied from January 2005 to May 2006.The following data were compared between 2 groups with 12 to 27 months follow-up:estimated blood loss,postoperative drainage,transfusion needs,surgi- cal time,length of hospital stay,postoperative back pain by visual analogue scale,complications,and the clinical and radiographic results.Results The microendoscopic approach was found to have a significantly less blood loss,less postoperative drainage,less needs of transfusion,less postoperative back pain,shorter re- covery time and shorter length of hospital stay.However,the microendoscopic approach needed significantly longer surgical time.There was no significant difference between 2 groups in the aspects of the complications and the clinical and radiographic results.Conclusion The one-level PLIF performed with microendoscopic approach minimize estimated blood loss,length of hospital stay,postoperative back pain.It also shows the ex- cellent surgical efficacy of the microendoscopic approach for suitable patients.

Objective To investigate the surgical treatment strategies and prognostic factors of cT4bM0 primary rectal cancer.Methods The clinical data of 53 patients with cT4bM0 primary rectal cancer who were admitted to the First Hospital of Peking University from January 2000 to December 2010 were retrospectively analyzed.All the patients received en-bloc multivisceral resection and postoperative chemotherapy.The survival and prognostic factors were analyzed.The patients were followed up via out-patient examination,phone call or mail,and the follow-up was ended till December 2012.The survival curve was drawn using the Kaplan-Meier method,and the survival was analyzed using the Log-rank test.Uni-and multivariate analysis were done using chisquare test and COX's proportional hazard model.Results Of all the 53 patients,20 received posterior pelvic exenteration (PPE),20 received total pelvic exenteration (TPE),3 received low anterior resection (LAR) +local resection of ballder,2 received LAR + ovariectomy,2 received LAR + local resection of ureter,1 received LAR + local resection of posterior vaginal wall,1 received LAR + vesiculectomy and vesectomy,3 received abdominoperineal resection (APR) + local resection of posterior vaginal wall,1 received APR + sacrectomy.R0 resection was achieved in all the patients.No intraoperative death was observed,and the incidence of postoperative complication was 9.4％ (5/53).The results of postoperative pathological examination showed that 2 patients were with well-differentiated adenocarcinoma,41 with moderate-differentiated adenocarcinoma,and 10 with poorly differentiated adenocarcinoma.Twenty-four patients were with lymph node metastasis.Four patients were in TNM stage Ⅰ,25 in TNM stage Ⅱ and 24 in TNM stage Ⅲ.Fifty-three patients were followed up postoperatively,and the median time for follow-up was 33 months (range,4-116 months).The overall 5-year survival rates was 57.3％.The 5-year survival rate for patients with or without lymph node metastasis were 77.1％ and 30.4％,respectively,with significant difference between the 2 groups (x2 =7.374,P ＜ 0.05).The 5-year survival rates of patients with malignant infiltration and inflammatory adhesion mere 51.0％ and 68.5％,with no significant difference (x2=1.148,P ＞0.05).The 5-year survival rates of patients with malignant infiltration and inflammatory adhesion in stage Ⅱ were 74.6％ and 85.7％,with no significant difference between the 2 groups (x2=0.118,P ＞ 0.05).The 5-year survival rates of patients with malignant infiltration and inflammatory adhesion in stage Ⅲ were 28.8％ and 37.5％,with no significant difference between the 2 groups (x2 =0.959,P ＞ 0.05).The results of univariate analysis showed that lymph node metastasis and TNM stage were the risk factors influencing the prognosis of patients with cT4bM0 primary rectal cancer (x2=6.468,6.596,P ＜ 0.05).The results of multivariate analysis showed that lymph node metastasis was the independent risk factor (RR =3.797,P ＜ 0.05).Conclusions En-bloc multivisceral resection should be the first surgical treatment choice for patients with cT4bM0 primary rectal cancer,and lymph node metastasis is the independent risk factor.Under the same N stage,the prognosis of patients with malignant infiltration or inflammatory adhesion is similar if R0 resection is achieved.

Objective To investigate the effect of noninvasive positive pressure ventilation treatment on patients with acute left heart failure and hyoxemia.Methods Sixty-two patients with acute left heart failure and hyoxemia were divided into control group (31 cases) and treatment group (31 cases).All patients were treated with a conventional therapy plan and patients in treatment were received noninvasive positive pressure ventilation beside conventional therapy.Blood gas analysis,plasma B-type natriuretic peptide (BNP) and clinical manifestation before and after treatment were monitored.Results The time of clinical manifestation al0leviation in treatment group was (33.7 ±7.9) min,shorter than that of control group ((55.9 ± 12.1) min,t =8.554,P ＜0.01).Compared with pre-treatment,heart rate (HR),respiratory rate(RR),mean arterial pressure(MAP),pH,oxygen saturation of blood (SaO2),arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide(PaCO2) and BNP in treatment group were improved significantly(HR:(133.89 ± 5.45) beat/ min vs.(87.27 ± 5.74) beat/min,t =32.794,P ＜ 0.01 ; RR:(34.25 ± 5.67) beat/min vs.(20.15 ± 2.54) beat/min,t =12.636,P ＜ 0.01 ; MAP:(104.52 ± 7.25) mmHg vs.(76.57 ± 3.76) mmHg,t =19.055,P ＜0.01; pH:(7.29±0.06) vs.(7.40 ±0.06),t=7.218,P＜0.01;SaO2:(81.52 ±5.01)％ vs.(97.16±1.27) ％,t =16.848,P ＜ 0.01 ; PaO2:(55.30 ± 7.14) mmHg vs.(92.80 ± 6.24) mmHg,t =22.019,P ＜0.01;PaCO2:(46.23 ±10.30) mmHg vs.(40.56 ±5.19) mmHg,t =2.737,P＜0.05;BNP:(831.59 ±292.65) ng/L vs.(265.52 ±65.39) ng/L,t =10.511,P ＜0.01).And after treatment,HR,RR,MAP,SaO2,PaO2,BNP in control group were improved compared with that before treatment (HR:(132.13 ± 5.31) beat/min vs.(92.15 ± 4.28) beat/min,t =32.638,P ＜ 0.01 ;RR:(34.96 ± 4.78) beat/min vs.(23.91 ± 3.27) beat/min,t=l0.634,P＜0.01;MAP:(102.56 ±7.14) mmHg vs.(82.83±3.52) mmHg,t =13.800,P＜0.01;SaO2:(82.15 ± 5.24) ％ vs.(93.16 ± 2.59) ％,t =10.488,P ＜ 0.01 ; PaO2:(54.56 ± 6.27) mmHg vs.(75.19 ±3.52) mmHg,t =15.974,P ＜0.01 ;BNP:(823.15 ±277.26) ng/L vs.(371.15 ±87.55) ng/L,t =8.656,P ＜0.01).Statistical differences of pH and PaCO2 were not found in the control group before and after treatment(pH:7.32 ± 0.05,t =1.426,P =0.159 ;PaCO2:(43.78 ± 6.74) mmHg,t =0.253,P =0.801).HR,RR,MAP,pH,SaO2,PaO2,PaCO2 and BNP in treatment group were more significantly improved than that of control group(t =3.795,5.056,6.767,5.703,7.721,13.686,2.107 respectively,P ＜ 0.01or P ＜ 0.05).Conclusion The therapy plan of noninvasive positive pressure ventilation on patients with acute left heart failure and hyoxemia can improve cardiac function and oxygenation quickly,and decrease the plasma BNP level.

ObjectiveTo explore the clinical diagnosis and surgical treatment of primary retroperitonealneurilemoma(schwannoma). MethodsClinicaldataof 47patientsof primary retroperitoneal schwannoma admitted and surgically treated from January 1995 to December 2009 were retrospectivelly reviewed.ResultsAs diagnosed by pathology there were 36 cases of Benign schwannoma,with a median age at onset of 41years, among those 11 patients were symptomatic, and 25 were asymptomatic. There were 11 malignant 11 cases, the median age was 38 years, among those 6 patients were symptomatic, and 5 were asymptomatic. The positive diagnostic rate of preoperative CT and MRI were 36. 2％ ( 17/47 ) and 58. 3％ ( 7/12 ) respectively. Immunohistochemically positive rates of S-100 were 100％ and 81.8％(9/11) in benign and malignant group respectively.All cases underwent surgical treatment. Surgical resection rates for benign and malignant groups were 100％ and 90. 9％(10/11)respectively. There was no perioperative death, Overall 5-year survival rates were 100％ and 45.5％ for benign and malignant tumors groups respectively. In benign group 2 cases recurred, in malignant group 4 cases recurred, and 3 had distant metastasis.ConclusionsPrimary retroperitoneal schwannomas are less common. It is difficult to make an accurate preoperative diagnosis. Surgery is the most effective therapy.Prognosis is good for benign and poor for malignant retroperitoneal neurilemomas.

Objective To investigate the ultrasound imaging findings of anatomical relationship between femoral artery and vein in children of different ages.Methods Sixty-five children aged 4 months-7 years were enrolled in this study.The children were divided into 3 age groups: group Ⅰ＜ 1 yr;group Ⅱ 1-3 yr and group Ⅲ＞ 3,≤ 7 yr.A protable ultrasound machine was used.The probe was placed at the level of inguinal ligament and 2 and 4 cm below inguinal ligament.The children were placed in supine position.The legs were placed in 2 positions:(1)extended and in standard anatomical position and(2)flexed and 45° abducted and 45° laterally rotated.Results The examination showed that at the level of inguinal ligament,the femoral vein lay behind and lateral to femoral artery in 91% of children.At the level of 4 cm below inguinal ligament,the femoral vein lay posterior and lateral to the femoral artery in all children.When the leg was placed in abducted and laterally rotated,the depth of femoral vein was reduced and the vein was less overlapped by artery in all children,especially in preschool children.Conclusion At the level of 4 cm below inguinal ligament,the femoral vein lies posterior and lateral to the femoral artery in children.When the leg is placed in abducted and laterally rotated,the depth of femoral vein is reduced and the vein is less overlapped by artery.It is indicated that femoral vein puncture should be performed at the level of 4 cm below inguinal ligament with the leg flexed and abducted in all children,especially in preschool children.

Objective To compare and evaluate the usefulness of diagnostic tests of IFA with HEp-2 cell substrate and ELISA coated with purified nuclear antigens for ANA in SLE.Methods Sera derived from 226 SLE cases and 183 healthy controls were tested for ANA and all parameters were compared such as sensi- tivity,specificity,accuracy,positive predictive value,negative predictive value,positive likelihood ratio,nega- tive likelihood ratio,result consistency,rank correlation coefficient and kappa of ANA detected by IFA and ELISA.Accuracy was evaluated by ROC for two methods.All 36 samples with different results from two meth- ods were detected for ENA.The correlation of titer to A ratio of different patterns as studied.Results The sensitivity of IFA and ELISA was 91.15% and 92.04% respectively for SLE patients,specificity was 96.17% and 92.90%,accuracy was 93.40% and 92.42%,positive predictive value was 96.71% and 94.12%,negative predictive value was 89.80% and 90.43%,no significant difference was found between the two methods (P＞0.05).No significant difference was found in accuracy of both methods by ROC (P=0.409).Good agreement was found between two methods with rank correlation coefficient (R=0.823) and kappa (k=0.825).All of 36 samples with different ANA results from two methods were detected for ENA.In 14 cases with IFA positive and ELISA negative,the titer of one case was up to 1:1000 and the pattern was Golgi by IFA,the titers of the rest were about cutoff level and the pattern were granular and nucleolus mostly.In 22 cases with IFA nega- tive and ELISA positive,11 cases of them had the A ratio ranged from 2.67～30.5.Positive rate of ENA was 14.29% in 14 cases with IFA positive and ELISA negative,68.18% in 22 eases with IFA negative and ELISA positive and the difference was significant (P＜0.01).Poor correlation of titer to A ratio for granular pattern samples (R=0.083),but good correlation for homogeneous pattern was found (R=0.595).Conclusion IFA as the recommended detecting method for ANA is intuitive and can provide more information by different pattem than ELISA but it needs fluorescence microscope and experienced technician.While ELISA is very simple and the concentration of ANA can be evaluated by A ratio value.ELISA can be a substitute method for ANA be- cause both IFA and ELISA have high sensitivity,specificity,accuracy,agreement rate,kappa and rank correla- tion coefficient.In addition,ELISA is more accessable for screen test because of low rate of false negative re- sult.Result of ELISA is more accurate if new and uncommon antigens are coated such as Golgi and nucleolus. The new work flow in which ELISA is used to screen out the positive ANA samples and IFA is used then to detect the nuclear pattern of ANA can save time,cost,and in turn improve work efficiency.