Objective To investigate the value of blood oxygenation level dependent (BOLD) MRI in detecting monkey cerebral ischemic penumbra (IP). Methods Six monkeys were used to make reversible middle cerebral artery occlusion (MCAO) model by an interventional microcatheter method. MR DWI, PWI mean transit time (MTT), T_2WI and quantitative T_2 map, T_2~* map were performed at MCAO (0 h) and 1,3,6,12,24,48 h after reperfusion. Reversible transverse relaxation rate (R_2') BOLD imaging was calculated using quantitative T_2 and T_2~* maps. Lesion volume percentage (lesion volume/bilateral hemispheres volume) were measured on 0 h DWI,48 h T_2WI and TTC staining. Ischemic area was subdivided into infracted core (high signal area on both 0 h DWI and 48 h T_2 WI), IP (high signal on 0 h DWI, iso on 48 h T_2 WI) and oligemia (0 h delayed MTT, iso signal on both 0 h DWI and 48 h T_2 WI). Relative R_2' (rR_2') was calculated to get ratio between the lesion and mirror area in contralateral healthyhemisphere. Paired t test and correlation analysis were used for comparison of lesion volume percentage. rR_2' values at each time point were compared by ANOVA. Results Reversible MCAO models were made successfully in 4 of 6 monkeys. Lesion volume porcentage on 48 h T_2 WI was reduced compared to that on Oh DWI [ (8.16±0.55)% vs (11.37±1.41)% ,t=6.472,P<0.05]. There was no significant difference in lesion volume percentage between TTC staining and 48 h T_2 WI[ (8.15±0.62)% vs (8.16±0.55)%, t= 0.150,P>0.05], which showed significant positive correlation (r=0.98, P<0.05). rR_2' values were significant different at each time point, with highest in ohgemia followed by IP and infarcted core (P< 0.05). rR_2' values in infracted core, IP and oligemia were: 0 h(1.129±0.108,1.329±0.081,1.584± 0.103,F=36.19,P<0.05),1 h(0.668±0.082,1.237±0.072,1.435±0.066,F=134.09,P<0.05), 3 h (0.536±0.075,1.453±0.081,1.770±0.141, F=256.30, P<0.05), 6 h (0.259±0.050,2.435± 0.131,2.957±0.177,F=803.25,P<0.05), 12 h(0.385±0.054,2.447±0.148,3.254±0.184,F= 743.74,P<0.05),24 h(0.083±0.026,1.968±0.127,3.101±0.144,F=1236.26,P<0.05),48 h (0.246±0.058,3.694±0.218,4.297±0.322, F=557.02, P<0.05). After reperfusion, rR_2' values in IP and oligemia showed increased trend with time evolution and reflected positive BOLD effect, while the infracted core showed decreased trend, reflecting negative BOLD effect. Conclusion R_2' BOLD can delineate IP from infracted core according to the difference of oxygen metabolic status in ischemic brain tissue.

OBJECTIVE:To reduce patient waiting time for drugs by improving work efficiency via the optimization of the in-telligent workflow of outpatient pharmacy. METHODS:The problems existing in each link in the workflow after the adoption of au-tomated drug dispensing machine in the outpatient pharmacy of our hospital were analyzed. Measures were developed and imple-mented,on the basis of the factors affecting each link including adding drugs,making up a prescription and dispensing drugs,to optimize the workflow. The effect after the optimization was evaluated,with the time it takes to make up a prescription and to dis-pense drugs and patient waiting time for drugs as the indexes. RESULTS:The averaged time it takes a pharmacist to make up a pre-scription and to dispense drugs and patient waiting time for drugs significantly reduced from 3.4 min,9.3 min and 12.7 min to 1.0 min,6.1 min and 7.1 min respectively,after taking measures such as adjusting the number of the drug types,tracks and positions in the machine,adding the contrasting pictures of the drugs which were similar on the system interface for adding drugs,standardiz-ing the process of adding drugs,improving and allocating information labels,adjusting the process of dispensing drugs and adding new small packages of drugs within 6 months. CONCLUSIONS:The optimized intelligent workflow in the pharmacy can reduce pa-tient waiting time for drugs,increase patient satisfaction and promote the development of intelligent pharmacy.

Objective To evaluate the CT findings of invasive pulmonary aspergillosis(IPA) in patients with leukemia.Methods Plain CT scanning of chest was performed in 9 cases of leukemia in company with IPA proved by sputum culture.5 of them underwent over twice CT re-scanning,CT findings of IPA were analysed.Results The lesions were seen more common in the bilateral upper lobe and dorsal segment of lower lobe,mainly located in the peripheral and sub-pleural lung field.Of the 9 cases,the lesions appeared as multi-nodular shadows in 5,single nodule in 2 and sub-pleural consolidation with ground-glass opacity around them in 2,of these 2 cases,one accompanied by multi-nodules.Halo-sign around the nodules in 6 cases and air cresent sign or cavity in 6 were seen.There were scattered ground-glass opacities and patchy attenuations in the bilateral lung in 4 cases.The adjacent pleura of lesion was slightly thinkened in 5 cases.Conclusion The incidence of IPA in leukemia patients is rather high,and CT features of IPA are of certainly characteristics.

In order to find out appropriate model to best disseminate laparoscopy for colorectal cancer clinical advanced technologies,it is necessary to establish a whole set of training system,which included selecting training site,intensive training,operation observation,advanced study at home and abroad,technical support,etc..Evaluation was based on operation time,hemorrhage in surgery,other injuries in surgery,conversion to open surgery and the ratio of in situ relapse in one year post surgery.These five indexes were compared between the training group and the control group with the gradually stable trend of learning curve as standard.Without previous laparoscopic surgery experience,the training group required 13.8±0.75,14±0.89,10.2±0.74,16.4±0.49 and 20.4±0.49 cases,respectively,to achieve expected proficiency,and the control group required 28.6± 1.69,29.2±1.16,27.8 ± 0.74,22.8 ± 0.40 and 25.4± 1.03 cases,respectively.The learning time required 13.4± 1.02 months on average for the training group and 27.8±2.13 months for the control group.In conclusion,the training system achieved obvious superiority to the controls to achieve expected skills and proficiency in laparoscopy for colorectal cancer.

Objective To analyze the resting-state functional connectivity of the left posterior inferior frontal gyrus in normal subjects with functional MRI and to investigate its preliminary application in post-stroke aphasia.Methods Eleven male patients with post-stroke aphasia and 11 male normal subjects were recruited in this study.Resting-state fMRI data were obtained with GE 1.5 T Twin speed MR Scanner.The fMRI data were processed with SPM2, AFNI and Matlab programs.Based on the results of previous fMRI study with category member generation task , the region of interest ( ROI ) was created in the left posterior inferior frontal gyrus The time course correlations between the ROI and other voxels within whole brain were analyzed.Intra-and inter-group analysis was performed with single sample t-test and two sample t-test.Results Brain regions showed positive resting-state functional connectivity with the ROI in normal subjects including left inferior/middle frontal gyrus , left premotor cortex , left precuneus , left insula , left putamen, right inferior frontal gyrus, right cerebellum and bilateral inferior parietal lobules (voxels 33-809, t=5.80-23.55,P<0.005,uncorrected).Brain regions functionally connected with the ROI in patients with post-stroke aphasia included left inferior/middle frontal gyrus , left premotor cortex , left precuneus , left inferior parietal lobules and right inferior frontal gyrus ( voxels 34-833, t =5.08-20.34, P<0.005, uncorrected ).The left fusiform gyrus was the only region showed significantly decreased functional connectivity with the ROI in the patients group (voxels 84,t=6.25,P<0.005, uncorrected).Conclusions The neural network related to language output exists in normal subjects at the resting-state.Resting-state functional connectivity can be used to investigate the neural mechanism of development and restoration of post-stroke aphasia.

Objective To investigate the substantia nigra (SN) and brainstem raphe (BR) echogenic features of Parkinson's disease (PD) patients with musculoskeletal pain.Methods A total of 115 PD patients recruited in the Second Affiliated Hospital of Soochow University from October 2014 to May 2016 were assessed with the following rating scales:Unified Parkinson's Disease Rating Scale (UPDRS),Hoehn and Yahr Staging Scale (H/Y),Hamilton Rating Scale for Depression (HRSD),Beck Depression Inventory Ⅱ (BDI-Ⅱ) and Visual Analogue Scale (VAS).All the subjects underwent transcranial sonography during the clinical evaluation.And the patients were divided into PD with musculoskeletal pain (n =54) and PD without musculoskeletal pain (n =61) groups,or PD with depression(n =74) and PD without depression(n =41) groups.Results Compared with PD patients without pain,PD patients with musculoskeletal pain had higher scores of UPDRS-Ⅱ,-Ⅲ,HRSD,BDI,NMSQ and H/Y (UPDRS-Ⅱ score:12.56 ±6.01 vs 8.79 ±4.38,t =-3.801,P ＜0.01;UPDRS-Ⅲ score:24.43 ± 12.43 vs 20.07 ± 11.12,t=-1.986,P=0.049;HRSD score:11.65-±6.94 vs 8.38-±5.36,t=-2.844,P=0.005;BDI score:14.09 ±6.20 vs 9.74 ±6.00,t =-3.826,P ＜0.01;NMSQ score:8.57 ± 4.06 vs 5.60 ± 3.38,t=4.193,P＜0.01;H/Y:2.0(1.5,2.6) vs 1.5(1.0,2.0),Z=-3.011,P=0.003).Positive BR was more frequent in depressed than in non-depressed PD patients without pain (63.6％ vs 14.3％;x2 =15.25,P ＜0.01).Positive BR was positively associated with sex(r =0.228,P =0.014),age(r =0.184,P =0.049),disease duration (r =0.196,P =0.035),and depression (r =0.396,P ＜ 0.01).However,positive BR did not correlate with musculoskeletal pain.No correlation was found between positive SN and clinical characteristics of PD patients.Conclusions PD patients with musculoskeletal pain have worse activity of daily living,more severe motor symptoms,more non-motor symptoms,and are more depressed.SN and BR echogenecity do not correlate with musculoskeletal pain,however,hypoechogenic or interrupted BR is associated with depression in PD patients.

Objective To study the activated status of insula during the performance of word generation task, and to explore the function of different part of insula with functional MRI (fMRI). Methods Twenty-eight subjects were recruited in this study (male 15, female 13), all of them underwent block-designed fMRI with word generation tasks and resting-state scan. SPM 5 and REST 1.3 were used to process the data. Bilateral anterior insula and posterior insula were selected as seeds to calculate the connectivity coefficiency with other voxels, and differences between the anterior and the posterior insula were compared. Results Bilateral anterior insula was significantly activated, while bilateral posterior insula was significantly deactivated. The functional connectivity areas with left anterior insula included right anterior insula, right posterior insula, supplementary motor area (SMA), left superior temporal gyrus, left middle frontal gyrus, left superior frontal gyrus, left inferior parietal lobe, middle cingulate gyrus, right striatum and right inferior frontal gyrus. The functional connectivity areas with left posterior insula included right posterior insula, left anterior insula, right superior temporal gyrus, middle cingulate gyrus, right precentral gyrus and right striatum. The functional connectivity areas with right anterior insula included SMA, left inferior frontal gyrus, right inferior parietal lobe, left inferior parietal lobe, left superior temporal gyrus, right precentral gyrus, right striatum, middle cingulate gyrus, left middle frontal gyrus, left striatum, right middle frontal gyrus, right inferior frontal gyrus and left transverse temporal gyrus. The functional connectivity areas with right posterior insula included right precentral gyrus, left superior temporal gyrus, left anterior insula, left posterior insula, right supramarginal gyrus and middle cingulate gyrus. Conclusion Anterior insula and posterior insula are functionally connected with different areas, and concerned with the language function in different manners. Left lateral anterior insula may play an important role in the language function.

Objective Unstable intertrochanteric fractures (ITFs) are mostly treated by proximal femoral nail antirotation (PFNA),Inter-Tan,Asian Hip,and other new internal fixation devices.But for complex unstable fractures,such as crushed lateral wall of the greater trochanter,the loss of fixation point on lateral wall slightly reduces the fixing effect.This study aimed to compare the biomechanical strengths between reversed less invasive stabilization system (LISS) and PFNA for treatment of unstable ITFs.Methods Forty synthetic femurs were used to simulate unstable ITFs in vitro and were fixed using the reversed LISS or PFNA.These fractures were divided into two groups depending on whether the lateral wall of the greater trochanter is intact or not (AO classification:31-A2.3 and 31-A3.3,respectively).The load-displacement of femur,stiffness,ultimate load,and cyclic fatigue resistance were detected using an incremental load test and a dynamic fatigue test through an MTS 858 test system.Results For both 31-A2.3 and 31-A3.3,the vertical sinking displacement (VSD) of the femoral head under 500 N load was insignificantly smaller after treatment with reversed LISS than with PFNA,and when the displacement was 5 mm,the femoral head bore insignificantly greater load.The fixation with reversed LISS resulted in greater axial stiffness of the femur but smaller ultimate load.During the same cycle in the dynamic fatigue test,the VSD was insignificantly smaller with the fixation of reversed LISS.Conclusion Reversed LISS and PFNA have similar biomechanical strength for unstable ITFs.This conclusion should be supported by additional large-size research on basic biomechanics and clinical application.This is the first comparative biomechanical study comparing reversed LISS and PFNA for unstable ITFs.

Objective To evaluate the role of autophagy in the spinal cord in the maintenance of postherpetic neuralgia (PHN) in mice.Methods Forty-eight SPF Kunming mice,aged 6-8 weeks,weighing 18-22 g,were divided into 4 groups (n=12 each) using a random number table:normal control group (group C),group PHN,PHN plus autophagy inducer rapamycin group (group PHN+R) and PHN plus autophagy inhibitor 3-methyladenine (3-MA) group (group PHN+3-MA).PHN model was established by intraperitoneal injection of resiniferotoxin 0.2 μg/g.In PHN+R and PHN+3-MA groups,rapamycin 1 μg/g and 3-MA 2 μg/g were intraperitoneally injected once a day for 14 consecutive days starting from 7 days after resiniferotoxin injection.The equal volume of normal saline was given instead in group PHN.The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured on 1st,3rd,6th,9th,12th and 14th days of administration of autophagy regulator (before administration).The animals were sacrificed after the last measurement of pain threshold,and the spinal cord was removed for examination of the ultrastructure and for determination of the expression of microtubule-associated protein light chain 3 Ⅱ (LC3 Ⅱ),LC3 Ⅰ,Beclin-1 and P62 by Western blot.The ratio of LC3 Ⅱ to LC3 Ⅰ expression (LC3 Ⅱ /Ⅰ) was calculated.Results Compared with group C,the MWT was significantly decreased,TWL was prolonged,LC3 Ⅱ/Ⅰ was increased,Beelin-1 expression was up-regulated,P62 expression was down-regulated (P＜0.05),and the number of autophagosomes was increased under electron microscope in group PHN.Compared with group PHN,the MWT was significantly decreased,TWL,was prolonged,LC3 Ⅱ/Ⅰ was increased,Beclin-1 expression was up-regulated,P62 expression was down-regulated (P＜0.05),and the number of autophagosomes was increased under electron microscope in group PHN+R,and the MWT was significantly increased,TWL was shortened,LC3 Ⅱ/Ⅰ was decreased,Beclin-1 expression was down-regulated,P62 expression was up-regulated (P＜0.05),and the number of autophagosomes was decreased under electron microscope in group PHN+3-MA.Conclusion The maintenance mechanism of PHN may be related to the excessive activation of autophagy in the spinal cord of mice.

Objective:To screen, obtain domestic and foreign evidence on the prevention and treatment of nausea and vomiting during pregnancy, and evaluate and summarize the quality of the evidence.Methods:We searched the Joanna Briggs Institute (JBI) , UpToDate, the Cochrane Library, PubMed, British Medical Journal (BMJ) , Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI) , WanFang Data, Yimaitong, VIP by computer. The search time limit was from January 1, 2011 to January 1, 2021. Four researchers independently screened the articles, and extracted and summarized the evidence that met the quality standards.Results:A total of 16 articles were included, including 4 guidelines, 1 evidence summary, 8 systematic reviews, 2 Meta-analysis and 1 expert consensus. Through the screening and acquisition of evidence for the prevention and treatment of nausea and vomiting during pregnancy, the 32 best evidences were finally summarized from 7 aspects including assessment and diagnosis, classification and grading, risk factors, basic management principles, prevention, non-drug treatment, and drug treatment.Conclusions:The prevention and treatment of nausea and vomiting during pregnancy should first evaluate the patient, determine the patient's symptoms and severity, analyze the risk factors, and conduct cognitive, psychological, and behavioral interventions for the patient, as well as non-pharmacological or drug treatment.