Objective To evaluate efficacy in detecting lung nodules at low-dose CT(LDCT) by nodule enhanced viewing(NEV).Methods One hundred and twenty seven patients who were referred to undergo low-dose CT (LDCT) for the evaluation of pulmonary metastasis or screening lung cancer were selected randomly.Two radiologists with at least 10 years experience read the images with normal clinical reading speed to find actionable nodules ≤ 2.0 cm in maximum diameter,and their consensus result was referred as Standard.NEV was adopted to detect the pulmonary nodules.Two residents with experience of less than three years read first detected suspicious nodules and recorded reading time,first consensus and mean time were recorded.Then,they made second decisions on the images with the help of NEV and the results and the reading time were recorded and analyzed by using wilcoxon test.The sensitivity and accuracy of NEV,residents and residents with NEV were analyzed.Results Standard,resident,NEV and resident with NEV detected 570,404,768 and 593 lung nodules ≤2.0 cm in maximum diameter,respectively.More than 60％ nodules were less than 0.5 cm in maximum diameter.The performance of NEV in detecting nodules ≤2.0 cm as well as nodules ＜ 0.5 cm in maximum diameter was significantly higher than that of the resident(Z =-6.887,P ＜0.01 and Z =-7.235,P ＜0.01),and the performance of resident with NEV indetecting nodules ≤2.0 cm as well as nodules ＜ 0.5 cm in maximum diameter was significantly higher than that of resident without NEV (Z =-6.606,P ＜ 0.01 and Z =-6.657,P ＜ 0.01).The resident,NEV and the resident with NEV detected nodules ＜ 20 mm in maximum diameter with sensitivities of 61.4％,86.3％ and 95.3％,and with accuracy of 56.1％,58.1％ and 87.6％,respectively.The resident achieved sensitivities of 51.4％,88.1％ and 94.8％,and accuracy of 47.0％,56.9％ and 87.5％ for nodules ＜5 mm in maximum diameter,respectively.The resident,NEV and resident with NEV spent 120-444 s,85-262 s and 131-1512 s per case to read the CT scans,respectively.The reading time of resident with NEV in was significantly higher than that of resident without NEV(Z =-9.781,P ＜ 0.01).The resident spent 23 s per NEV mark.Conclusion NEV considerable improves the resident's performance in lung nodule detection,especially in maximum diameter ＜ 0.5 cm nodule detection.

ObjectiveTo review the experience of video-assisted thoracoscopic resection for posterior mediastinal neurogenic tumors,to investigate the technical features and difficulties of thoracoscopic approach.MethodsFrom May 2001 to June 2011,58 patients underwent thoracoscopic resection of posterior mediastinal tumors in our institution,including 36 males and 22 females.The average age of the patients was 38.7 years.The average tumor size was 4.9 cm.16 patients had neurogenic or pulmonary symptoms at the time of diagnosis,while the other 42 were asymptomic.24 lesions were located in the left side,33 lesions in the right side,1 lesion in bilateral sides.All procedures generally required 3 ports,and intracapsular enucleation was preferred,supplying vessels were ligated by hemoclips or Hem-o-lock clips; the nerves of origin were cut off at both edges of the tumor.For bulky tumor,dense adhesion,and massive bleeding,open conversions were performed by extending the incision anteriorly to 6-10 cm.ResultsAll procedures were successfully performed without death event occurring.The average operating time was 127.2 min.The average intraoperative blood loss was 206.4 ml.3 cases requied blood transfusion.The average chest tube duration was 2.72 days.The average postoperative stay was 5.19 days.53 procedures were performed entirely under thoracoscopy to achieve gross-total resection.Conversions to an open procedure were necessitated in 5 patients (8.6％).7 patients experienced post-operative complications,with 4 Horner syndromes.There were 25 neurilemomas,23 neurofibromas,8 ganglioneuromas,1 paraganglioma,and 1 malignant paraganglioma.No local recurrence was seen after an average follow-up of 44.9 months.ConclusionVideo-assisted thoracoscopic removes of the posterior mediastinal tumors are safe,reliable and minimally invasive for selected patients with mastered throcoscopic skills.intracapsular enucleation is a safe procedure with reduced risk,while tumors larger than 6cm and located in the apex are with increased risk.

Age Factors ; Cardiopulmonary Bypass ; Child ; Child, Preschool ; Humans ; Infant ; Infant, Newborn ; P-Selectin ; blood ; Platelet Glycoprotein GPIb-IX Complex ; analysis

Objective To explore the relationship between the level of tumor necrosis factor related apoptosis inducing ligand(TRAIL) and death receptor 5(DR5) and atherosclerosis(AS).Methods Eighty-three patients were divided into two groups: Sixty-one in the coronary artery disease(CAD) group and 22 in normal coronary artery group.Plasma soluble TRAIL(sTRAIL) and soluble DR5(sDR5) levels from these people were assayed by ELISA.The level of TRAIL and DR5 protein expression in coronary arteries were detected by immunohistochemisty statining.Results Plasma sTRAIL and sDR5 significantly increased in the CAD group(P

Objective To evaluate the epidemiological characteristics of brucellosis in Jinan city and to identify its cause in order to provide evidence for development of specific preventive strategies in the future.Methods Epidemic information of the disease and survey data of brucellosis cases from 2002 to 2008 in the Infectious and Endemic Disease Control Jinan Centre for Disease Control and Prevention were analyzed statistically.Results From 2002 to 2008, 52 cases were diagnosed as brucellosis, among which 39 cases from Zhangqiu city.The incidence rate ranged from 0.02 to 0.10 hundred thousandth from 2002 to 2006, and 0.25 and 0.26 hundred thousandth in 2007 and 2008, respectively. The disease was found each mouth throughout the year, marked with summer peak[38.46%(20/52)]. Patients increased year after year in summer and spring seasons(r = 0.92, P ＜ 0.01) .The disease was most commonly found in 30 - 59 age group[69.23%(36/52)];men women incidence ratio was 1.67: 1.00;farmers accounting for 94.23%(49/52). There were 5 clusters of family outbreak brucellosis, involving 12 cases. Forty five patients contacted with sheep, accounting for 86.54% (45/52). Conclusions Brucellosis epidemic in Jinan is in an upward trend, mainly in summer and spring, elderly and middle-aged men farmers are the majority of patients. Zhangqiu of Jinan city is a key place for prevention and control of brucellosis;source of infection is not completely eliminated, exotic livestock have not been effectively quarantined, practitioners with weak sense of self-protection is the main reason of the epidemic rise.

Objective To investigate the features and risk factors associated with lymph node metastasis in colorectal neuroendocrine neoplasm.Methods Clinical and pathological data of 63 patients with colorectal neuroendocrine neoplasm treated in Yinzhou People's Hospital between June 1997 to December 2012,were analyzed retrospectively.Comparisons of categorical data and univariate analysis of risk factors of lymph node metastasis were conducted by x2 test,multivariate analysis was conducted by Logistic regression analysis.Results Of the 63 patients the rate of regional lymph node metastasis was 30％ (19/63) with 58％ limited to para-intestinal lymph nodes in 11 cases,26％ limited to mesenteric lymph nodes in 5 cases,and 16％ limited to mesenteric root central lymph nodes in 3 cases.No metastasis exceeding central lymph nodes was observed.According to univariate analysis,tumor size,depth of invasion,ulceration in mucous membrane,invasion of lymphatic vessel and pathological grading suggested by WHO were related to regional lymph node metastasis (P ＜ 0.01).Multivariate regression analysis revealed that tumor size,invasion of lymphatic vessel and pathological grading were independent risk factors for lymph node metastasis in colorectal neuroendocrine neoplasm (P ＜ 0.05).Conclusions Colorectal neuroendocrine neoplasm with larger tumor size,invasion of lymphatic vessel or higher grade (G2,G3) has high risk of regional lymph node metastasis.

Objective:Coherence analysis of the EEG is used to study the synchrony or coupling between cortical areas underlying the electrodes. However,the effects of intravenous anesthetics on EEG coherence have not been defined. Method: Forty patients were administered with intravenous thiopental (5mg/kg),propofol (2.5mg/kg ), ketamine(4mg/kg)or fentanyl(10?g/kg). The changes of coherences in total and in a given frequency band of the EEG(?.?.?.?) were measured with an AXON Systems Sentinel-4 Neurological monitor between two pair electrodes(Cz-F_7 vs Cz-F_8 and Cz-A_1 vs Cz-F_2). Result: The anesthetics had significantly different effects on the coherence by either increase or decrease. The variability of the coherences had no regular pattern,and no relationship to excitement or depression of the anesthetics and to potency of them. Conclusion:Each anesthetic above selectively depresses and excites generators of the EEG in quite different ways.

Objective To explore the diagnostic value of color Doppler echocardiography in the patients with anomalous origin of coronary artery.Methods Six patients were studied using color Doppler echocardiography.The origin sites,running courses,blood flow directions of coronary arteries, other accompanied cardiovascular abnormalities and valvular regurgitations were investigated.The diameters of coronary artery trunks and left ventricular ejection fraction (LVEF) were measured.And the results were compared with those of coronary angiography and surgery.Results Left coronary artery(LCA) originated from pulmonary artery(PA) in 4 cases,left anterior descending(LAD) branch originated from PA in 1 case,and accessory coronary artery originated from PA in 1 case.The main accompanied cardiovascular abnormalities included ventricular septum defect,atrial septum defect,complete endocardial cushion defect,and so on.For all the patients,the diagnostic results by echocardiography were consistent with catheterization and surgery.High correlations existed between echocardiographic and catheterization measurements for left and right coronary artery diameter and LVEF (r= 0.94 , 0.96 , 0.89 ,respectively,all P 0.05 ).Conclusions Color Doppler echocardiography can accurately diagnose the patients with anomalous origin of coronary artery, provide reliable information for surgical treatment.

This study was aimed to observe changes of key molecular in insulin signaling pathway in the hypothala-mus of rats to explore the mechanism of spleen yin deficiency diabetes-associated cognitive decline (DACD) and Zibu Piyin Recipe (ZBPYR) in order to provide new ideas and new clues for treatment of DACD. Rats were randomly divided into five groups, which were the control (Cont) group, diabetes (DM) group, spleen yin deficiency (pi) group, spleen yin deficiency diabetes (piDM) group and the ZBPYR group. Insulin receptor substrate 1 (IRS-1) serine phos-phorylation levels and protein kinase B (PKB/Akt) serine phosphorylation levels which were involved in the insulin signaling were observed by western blotting in the hypothalamus to determine whether there were insulin signaling obstacles in the hypothalamus of rats. The results showed that the expression of p-IRS-1ser in the DM group, pi group and piDM group was increased compared with the Cont group (P< 0.05); while the p-Akt expression of the DM group and piDM group was decreased (P< 0.05). The expression of p-IRS-1ser in the ZBPYR group decreased compared with the DM group and piDM group (P< 0.05); while the level of p-Akt increased compared with the DM group and piDM group (P < 0.05). It was concluded that insulin signaling was not transduced normally in the hy-pothalamus of the DM group, pi group and piDM group. Insulin resistance may occur in the hypothalamus. And ZBPYR can correct insulin signaling transduction disorder.

ObjectiveSummarize 500 cases of non-small cell lung cancer (NSCLC) that has accepted complete videoassisted thoracoscopic (VATs) lobectomy procedure in People's Hospital of Peking University,to report the mid-term follow-up results,and to evaluate the safety and effectiveness of VATs lobectomy.MethodsBetween September 2006 and September 2011,500 cases of non-small cell lung cancer that has accepted complete thoracoscopic lobectomy in the People's Hospital of Peking University were reviewed (267 male,233 female).Median patient age was 62.3 years.The average maximal diameter of solid tumors was 2.65cm.There are 496 cases of initial treat patients and 4 cases of operation after radiation and chemotherapy.This group consisted of lobectomies of left upper lobe ( n =129),left lower lobe ( n =73 ),right upper lobe ( n =163 ),right middle lobe x( n =47 ),right lower lobe( n =89 ).The operation procedure was complete VATs lobectomy combined with systematic lymph node resection ( at least 3 groups of lymph nodes in the mediastinum area),including 480 cases of purely lobectomy,13 cases of compound lobectomy (pulmonary lobe + pulmonary lobe,or pulmonary lobe + pulmonary segment),3 cases of segmentomy,2 cases of pneumonectomy,1 case of sleeve lobectomy and 1 case of bilateral lobectomy.ResultsAll procedures were carried out smoothly without serious complication,except 1 case of death of an advanced age patient due to multi-organ failure after the operation period.The average surgical duration was 198.1 min,and average blood loss was 214.6ml.There are 5 cases of postoperative hemorrhage,identified as pulmonary artery residual ooze blood,in which 4 cases of bleeding were stopped through re-operation,and 1 case was improved through conservative treatment.The median lymph nodes dissection was 5.7 group and median number of resected lymph nodes was 16.9.The median postoperative chest tube drainage duration was 7.8 day,and median postoperative hospital stay was 10.2 day.There were 45 cases (9.0％) of conversion to open thoracotomy and 87 cases ( 17.4％ ) of slight complications,including 32 cases of cardiac abnormalities,such as continuous arrhythmia,28 cases of air leakage beyond seven days,9 cases of pulmonary infections or atelectasis,6 cases of chylothorax,and 16 cases of other complications.The results of pathology show 363 cases of adenocarcinoma,85 cases of squamous carcinoma,12 cases of adenosquamous carcinoma,28 broncho-alveolar cell carcinoma,6 cases of large cell lung cancer and 6 cases of other lung cancer.The 1-year disease free survival (DFS) was 90.2％ and 1-year overall survival (OS) was 94.3％.The 3-year DFS was 76.4％ and 3-year OS was 81.3％.ConclusionCompletely video-assisted Thoracoscopic lobectomy procedure was a safe and effctive procedure for patients with non-small cell lung cancer.