Objective To investigate the CT appearances of atypical renal angiomyolipoma to raise the CT diagnosing level and search for the differential points from renal angiomyolipoma. Methods Twenty-one patients with atypical renal angiomyolipoma and 24 patients with renal carcinoma underwent CT scan and enhanced scanning. Results CT results showed hyperintense in 12 of all 21 lesions of atypical renal angiomyolipoma,with iso-intensity in 6,hypointense in 3,and levering-cortex-up sign in 9 cases. The tumor body showed homogeneous enhancement on CT enhanced scanning and prolonged enhancement was noted in 7 cases. CT showed hyperintense in 3 of all 24 lesions of renal carcinoma,with mixed intensity in 5,hypointensity in 16,calcification in 2 cases. The majority of the tumor body showed heterogeneous enhancement on CT enhanced scanning with cortical hyperintensity and medullary low-intensity,and with contrast appeared fast wash-in and wash-out. Of all cases,8 presented with pseudo-capsule,7 with tumor embolus formation in the renal vein and inferior vena,10 with retroperitoneal lymphadenectasis,and 3 with intrahepatic metastasis. Conclusion CT scanning proves to play critical role in differentiating the atypical renal angiomyolipoma from renal carcinoma.

Objective To determine the CT features of the 16 - slice Spiral CT (MSCT) for aortic dissection (AD). Methods 16 - slice spiral CT were porformed in 25 patients of aortic dissection. All of patients were performed with unenhanced, contrast - enhanced scanning and three - dimensional reconstruction. Results 10 patients were normal on unenhanced and 15 patients were seen enlargred diameter of aorta. Intimal calcification and intimal displacement was seen in 8 cases and outer wall calcification was presented in 7 cases. After contrast - enhanced scanning, true and false lumen and intimal flap of AD could be shown in all of 25 cases (100%). The entry tears was revealed in 22 cases (88.9%). Beak sign was presented in all cases, but it was seen in the false lumen. The larger lumen was the false lumen in 88.5% of the cases. Intraluminal thrombus was presented in 12 cases. Conclusion Multislice spiral CT angiography is a safe,no - traumation,fast and accurate examination method. It can fully display theintimal flap,the true and false lumen and tear entrance, as well as the branches involved details and is therefore of important value for the diagnosis of aortic dissection.

Objective To investigate the effect of stanozolol on nitrogen balance ,grip strength and clinical outcomes of criti‐cal patients with high nutrition risk .Methods We enrolled patients who were admitted to the ICU of Guizhou provincial Hospital during the time period from January 2014 to June 2014 and ,as patients with high nutrition risk .Patients ,who received same base nutritional support program ,were divided into two groups .Treatment group who were treated with stanozolol administrated with gastric or jejunal tube for 7 days by 4 mg Tid .The control group whose members underwent placebo simultaneously with the treat‐ment group .The nitrogen balance ,grip strength of both groups was measured when at admitted and 4th as well as 7th day .Prealbu‐min ,total bilirubin ,alanine aminotransferase ,and aspartate aminotransferase were measured when at the same time and before leave hospital .The duration of the mechanical ventilation ,ICU stays ,hospital stays and mortality within 28 days were recorded .Results There was no statistical significance in the differences between all the indicators of the two groups at admission(P>0 .05) .The du‐ration of mechanical ventilation ,ICU stays ,hospital stays were decreased significantly in the treatment group (P<0 .05) compared to the control group .But the mortality within 28 days had no significant difference between two groups (P>0 .05) .Nitrogen bal‐ance ,prealbumin ,grip strength and liver function parameters in the treatment group were significantly higher than they were been at admitted and control group at 4th and 7th day (all P<0 .05) .Liver function parameters of treatment group gradually decreased to the normal range before discharge .Conclusion In critically ill patients treated with anabolic steroid stanozolol ,can promote protein synthesis ,reduce muscle and other lean tissue decomposition ,improve clinical symptoms ,short the length of hospital stay and ICU stay .But we should pay more attention on liver function in critically ill patients who treated with stanozolol .

Objective To study the clinica features, diagnosis and surgical treatment of simple and complex macromastia. Methods The clinical and pathological data of 21 patients with macromastia in our hospital from 1990 to 2000 were analysed retrospectively. Simple macromastia in 16 patients with 29 breasts, complex macromastia in 5 patients with 8 breasts. Results The average age of patients was 23 years old. All the 21 patients were treated surgically. Among the 5 patients with complex macromastia, subcutaneous mastectomy and reconstruction were performed on 2 patients with breast fibroadenomatosis; of the 2 patients with giant fibroadenoma, one underwent tumor excision, the others were subjected to tumor excision with reduction mammaplasty; the last one with breast fibrous disease, selective partial breast excision and reduction mammaplasty was performed. All the patients had satisfactory mammary appearance and hadn't recurrrence of the breast disease in follow up period. Conclusions (1) Macromastia often happens in the adolescent and young women. (2) It is necessary to do biopsy during operation for distinguishing the simple from the complex macromastia. (3) The treatment for simple macromatia is reduction mammaplasty; for complex macromatia is dissection of the disease area completely and redution mammaplasty simultaneously. For macromastia with fibroadenomatosis, subcutaneous mastectomy with reconstruction can prevent tumor recurrence and get better mammary appearance.

Objective　To study the clinica features, diagnosis and surgical treatment of simple and complex macromastia. Methods　The clinical and pathological data of 21 patients with macromastia in our hospital from 1990 to 2000 were analysed retrospectively. Simple macromastia in 16 patients with 29 breasts, complex macromastia in 5 patients with 8 breasts. Results　The average age of patients was 23 years old. All the 21 patients were treated surgically. Among the 5 patients with complex macromastia, subcutaneous mastectomy and reconstruction were performed on 2 patients with breast fibroadenomatosis; of the 2 patients with giant fibroadenoma, one underwent tumor excision, the others were subjected to tumor excision with reduction mammaplasty; the last one with breast fibrous disease, selective partial breast excision and reduction mammaplasty was performed. All the patients had satisfactory mammary appearance and hadn't recurrrence of the breast disease in follow up period. Conclusions　(1) Macromastia often happens in the adolescent and young women. (2) It is necessary to do biopsy during operation for distinguishing the simple from the complex macromastia. (3) The treatment for simple macromatia is reduction mammaplasty; for complex macromatia is dissection of the disease area completely and redution mammaplasty simultaneously. For macromastia with fibroadenomatosis, subcutaneous mastectomy with reconstruction can prevent tumor recurrence and get better mammary appearance.

Objective To evaluate the clinical results of self-designed double-pivot extracorporeal reduction device in internal fixation with percutaneous pedicle screws for thoracolumbar fractures.Methods From January 2014 to May 2015,a total of 41 patients with thoracolumbar fracture without neurological symptoms underwent minimally invasive fixation with percutaneous pedicle screws.Of them,22 were treated with our self-designed double-pivot extracorporeal reduction device and the other 20 with common single-pivot extracorporeal reduction device.The 2 groups were compared in terms of pre-and postoperative kyphotic angles,correction rates and anterior,middle and posterior heights of injured vertebrae to evaluate the therapeutic effects of the self-designed double-pivot extracorporeal reduction device.Results The patients were followed up for 6 to 18 months (average,12.3 months).No iatrogenic impairment of nerve root,postoperative infection,or implant failure happened.Compared with preoperation,significant improvements were observed in all the patients regarding cobb's angle,anterior,middle and posterior heights of the fractured vertebral body (P ＜ 0.05).Compared with the single-pivot group,the double-pivot group were significantly superior in the kyphotic angle,correction rate,and anterior and middle heights of the injured vertebrae(P ＜ 0.05),but there was no significant difference between the 2 groups in the recovery of posterior height of the fractured vertebral body (P ＞ 0.05).Conclusion Compared with the single-pivot reduction device,the self-designed double-pivot reduction device may be preferable in percutaneous pedicle screw fixation for thoracolumbar fractures.

BACKGROUND:Monoaxial pedicle screws are not conducive to the instal ation during percutaneous pedicle screw technique, but it has better mechanical conductivity and stability than polyaxial pedicle screws. How to select and use these two kinds of screws in the clinic to exert their advantages and to further elevate efficacy has become a subject worthy of reflection. OBJECTIVE:To compare the clinical efficacy of percutaneous pedicle screw placement for thoracolumbar fracture using monoaxial and polyaxial pedicle screws at different placement selections. METHODS:A total of 46 cases of thoracolumbar fracture without neurological symptoms underwent minimal y invasive percutaneous pedicle screw fixation. 25 patients (monoaxial screw group) were treated with monoaxial pedicle screws and the other 21 ones (polyaxial screw group) with polyaxial pedicle screws. Kyphotic angle, correction rate, correction loss rate and height of injury vertebrae were compared before and after fixation in both groups. The therapeutic effects of monoaxial and polyaxial percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures were evaluated. RESULTS AND CONCLUSION:(1) Fixation time, blood loss, complication and hospital stay were not significantly different in both groups (P>0.05). (2) Kyphotic angle and height of the fractured vertebra body were significantly different between the two groups (P<0.05). (3) The restoration of anterior height of injured vertebrae, kyphotic angle and correction rate were better in the monoaxial screw group than in the polyaxial screw group after treatment (P<0.05). The correction loss rate was significantly better in the monoaxial screw group than in the polyaxial screw group during last fol ow-up (P<0.05). However, there was no significant difference in the posterior height of injured vertebraeafter fixation (P>0.05). (4) These findings indicate that compared with the polyaxial percutaneous pedicle screw fixation, the monoaxial pedicle screw may be preferable in percutaneous pedicle screw fixation for thoracolumbar fractures, has more satisfactory fracture distraction reduction, and has less postoperative correction loss rate.

Objective Based on Chinese guidelines for the management of ischemic stroke, a standardized stroke management program was performed to provide intensive education and training for medical physicians, aiming to enhance their knowledge and ability for ischemic stroke prevention and treatment, thereby reducing patients′ in-hospital cost and length of stay, and improving patients′ clinical prognosis. Methods This study was conducted in 20 general hospitals throughout Hainan province. A total of 163 physicians from 20 hospitals involved in the management of stroke patients were trained by highly experienced physicians based on the Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2014 and the Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack 2014. Prior to and post the standardized stroke management training, the data of 3218 and 3367 patients with ischemic stroke were respectively collected. Quality of life assessments including the Barthel index (BI) and the modified Rankin Scale (mRS) score of all patients were recorded at baseline and after discharge. The length of stay and in-hospital cost were directly collected from the hospital information system. Results Physicians′ knowledge and ability manifested as testing scores were significantly improved after training (78.2 ± 15.5 vs 55.6 ± 10.7, t=69.1, P<0.01). The average length of stay of post-training patients was significantly shorter than that of pre-training patients ((8.7 ± 0.9) vs (11.7 ± 1.5) days, t=97.9, P<0.01). The average in-hospital cost of post-training patients was significantly less than that of pre-training patients ((7681.7 ± 1397.7) vs (11846.2 ± 2514.6) Yuan, t=82.5, P<0.01). Both BI (68.2 ± 3.2 vs 43.5 ± 5.3, t=227.7, P<0.01) and mRS score (2.74±0.51 vs 3.65±0.71, t=59.5, P<0.01) were significantly improved for post-training patients. Multivariate linear regression analysis illustrated that standardized stroke management was negatively associated with in-hospital cost (r=-0.461, P<0.01), length of stay (r=-0.357, P<0.01) and mRS score (r=-0.298, P<0.01), and was positively associated with levels of BI (r=0.376, P<0.01). Conclusion Standardized stroke management program might be a cost-effective choice for the management of ischemic stroke as it reduces the in-hospital cost and improves patients′BI and mRS levels.

Objective To investigate the value of multimodal MRI radiomics in predicting muscle-invasive bladder cancer.Methods A total of 178 patients with pathology diagnosis of bladder cancer were retrospectively collected,including 31 cases of muscle invasive bladder cancer(MIBC)and 147 cases of non-muscle invasive bladder cancer(NMIBC).Patients were randomly divided into training group and testing group at a ratio of 7︰3.The range of bladder tumors in T2WI,diffusion weighted imaging(DWI)and apparent diffusion coefficient(ADC)images were segmented as volume of interest(VOI)by using ITK-SNAP software.Radiomics features were extracted through A.K software.The optimal radiomics features were obtained through radiomics algorithm and least absolute shrinkage and selection operator(LASSO)method.Finally,the logistic regression analysis method and random forest model method were used to construct prediction models.The performance of prediction models was evaluated by the receiver operating characteristic(ROC)curve.Results This study constructed four groups of models containing T2WI prediction model,DWI prediction model,ADC prediction model,and T2WI+DWI+ADC prediction model.The area under the curve(AUC)of T2WI,DWI,and ADC prediction models for identifying MIBC and NMIBC were separately 0.920,0.914,and 0.954 in the training group while those were respectively 0.881,0.773,and 0.871 in the testing group.There was no statistical significance between T2WI,DWI,and ADC prediction models.In training and testing groups,the AUC of T2WI+DWI+ADC prediction model were respectively 0.959 and 0.909,which were higher than the single sequence prediction model.The sensitivity and specificity of the training group were 0.905 and 0.853 and the sensitivity and specificity of the testing group were 0.778 and 0.795.Conclusion MRI radiomics prediction model can effectively differentiate MIBC and NMIBC.The T2WI+DWI+ADC prediction model shows better prediction efficiency.

In order to meet the requirements in the cooperation and competition experiments for an individual patient in clinical application, two human interactive behavior key-press models based on hidden Markov model (HMM) were proposed. To validate the cooperative and competitive models, a verification experimental task was designed and the data were collected. The correlation of the score and subjects' participation level has been used to analyze the reasonability verification. Behavior verification was conducted by comparing the statistical difference in response time for subjects between human-human and human-computer experiment. In order to verify the physiological validity of the models, we have utilized the coherence analysis to analyze the deep information of prefrontal brain area. Reasonability verification shows that the correlation coefficient for the training data and the testing data is 0.883 1 and 0.578 6 respectively based on cooperation model, and 0.813 1 and 0.617 8 respectively based on the competition model. The behavioral verification result shows that the cooperation and competition models have an accuracy of 71.43% respectively. The results of physiological validity show that the deep information of prefrontal brain area could been extracted based on the cooperation and competition models, and reveal the consistency of coherence between the double key-press cooperative and competitive experiments, respectively. Above all, the high consistency is obtained between the cooperatio/competition model and the double key-press experiment by the behavioral and physiological evaluation results. Consequently, the cooperation and competition models could be applied to clinical trials.