Objective To assess the influence of tube current and tube voltage on the CT attenuation,radiation dose,and image quality.Methods A total of 113 saline solutions with decreasing dilution of contrast medium (370 mg I/ml) was produced.MDCT scan was performed with 15 series of different settings of tube current and tube voltage.CT attenuations with 15 series of different settings were all measured,and influence of tube current and tube voltage on CT attenuations was analyzed.CT dose index (CTDIvol) was recorded.The CT attenuations with different tube voltage and current were compared with one-way ANOVA and Kruskal-Wallis rank sum test.The correlation of CT attenuation with different tube voltage and the influence of tube voltage and current on radiation dose and image quality were tested by correlation analysis.Results Tube current (250,200,150,100,and 50 mA) had no significant effect on CT attenuation (F =0.001,0.008,0.075,P ＞ 0.05),while tube voltage (120,100,and 80 kV) had significant effect (H =17.906,17.906,13.527,20.124,23.563,P ＜ 0.05).The correlation between CT attenuation and tube voltage was determined with equation:CT attenuatio N100 kV =1.561 × CT attenuatio N120kv + 4.0818,CT attenuatio N80kV =1.2131 × CT attenuatio N120kv + 0.9283.The influence of tube voltage on radiation dose and image quality was also analyzed,and equations were also obtained:N120 kV =-5.9771Ln(D120 kV) + 25.412,N100 kV =--10.544Ln (D100 kV) + 36.262,N80 kV =-25.326Ln(D80kv) +62.816.According to the results of relationship among CT attenuation,radiation dose,and image quality,lower tube voltage with higher tube current can reduce the radiation dose.Conclusions Lower tube voltage can reduce the radiation dose.However,CT attenuation was influenced,and correction should be done with the equations.

Objective To study the effect of intra arterial thrombolysis in combination with basic fibroblast growth factor (bFGF), and the protecting mechanism of the bFGF. Methods 50 male Wistar rats were subjected to middle cerebral artery occlusion (MACO) for 4 hours by a single fibrin rich clot. The rats were randomly assigned to the following two expremental groups: 1) treatment with urokinase alone; 2) treatment with urokinase and bFGF. The neurological deficits and the volume of lesions on MRI T2WI were observed at different periods after therapy. The expression of bax were analyzed by immunuohistochemical method at each time point. Results Bax expression increased at 3 hours after reperfusion, and reached the peak level at 12h reperfusion. At 6h after therapy, expression of bax ( P

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.

OBJECTIVETo observe the effects on post-stroke depression treated with acupuncture at the acu points based on ziwuliuzhu (the midnight-noon ebb-flow theory).

METHODSNinety-three patients were randomized into a comprehensive group, a ziwuliuzhu group and a prozac group, 31 cases in each group. In the ziwuliuzhu group, acupuncture was applied to the acupoints based on ziwuliuzhu, once a day, 5 times in a week. In the prozac group, fluoxertine hydrochloride (prozac) was prescribed for oral administration, once a day, 20 mg each time. In the comprehensive group, acupuncture based on ziwuliuzhu combined with the oral administration of prozac were adopted and the treatment frequency was the same as the ziwuliuzhu group and the prozac group. The 4-week treatment was taken as one session in the three groups and 6 sessions were required totally. The clinical efficacy and the Hamilton depression rating scale (HAMD) score and the adverse reaction were compared among the 3 groups.

RESULTSThe total effective rate was 96.8% (30/31) in the comprehensive group, better than 83.9% (26/31) in the ziwuliuzhu group and 80. 6% (25/31) in the prozac group (both P<0.05). In 4, 12 and 24 weeks of treatment, HAMD score was lower significantly than that before the treatment in the three groups (all P<0.05), and the score in the comprehensive group at each time point after treatment was lower than the other two groups (all P<0.05). In 4 and 12 weeks of treatment, there were not different significantly between the ziwuliuzhu group and the prozac group (both P>0.05). In 24 weeks of treatment, HAMD score in the ziwuliuzhu group was lower than that in the prozac group (P<0.05). For the adverse reaction, there were 2 cases in the comprehensive group, 6 cases in the prozac group and 0 case in the ziwzuliuzhu group.

CONCLUSIONThe comprehensive therapy of acupuncture at the acupoints based on ziwuliuzhu and oral administration of prozac is superior to either the simple oral administration of prozac or the ziwuliuzhu acu-puncture in terms of clinical efficacy and the improvements in depressive state. Regarding the clinical efficacy, the impact of simple ziwuliuzhu acupuncture is not different significantly as compared with the simple oral administration of prozac, but it is better than the simple oral administration of prozac in terms of the long-term HAMD score and safety.

Acupuncture Points ; Acupuncture Therapy ; Aged ; Aged, 80 and over ; Depression ; etiology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Stroke ; complications ; Treatment Outcome

BACKGROUND:As a more common method in the orthopedic field, the method of intra-articular injection drugs has distinct curative effects, but there are some complications. In a certain extent, this method caters to the psychological fear of surgery, and can serve as a kind of conservative treatment. But some experts believed that because of the limit of sterile conditions, intra-articular injection of drugs wil increase the risk of intra-articular infection and they opposed this method.
OBJECTIVE:To review the efficacy and adverse reactions of intra-articular injection drugs in recent years, and explain clinical applications of intra-articular injection drugs in orthopedics.
METHODS:A computer-based search was conducted in PubMed and Wanfang database for articles related to the application of intra-articular injection drugs in orthopedics published between January 2007 and December 2013. The English and Chinese key words were“intra-articular, injection, orthopaedics, tranexamic acid, hyaluronic acid, corticosteroid, drugs”. Data were checked in the first trial, old articles and repetitive studies were excluded. The relevant 43 articles accorded with inclusion criteria were reviewed.
RESULTS AND CONCLUSION:In orthopedics, the method of intra-articular injection drugs is simple, economic and effective, but at the same time, there are some side effects. Tranexamic acid by intra-articular injection can significantly reduce blood loss after total joint replacement, is safety and economic. Intra-articular injection joint lubricant can reduce internal friction of joints and improve the adhesion of joint cavity, can be used as a good conservative treatment for osteoarthritis. Intra-articular injection hormone drugs can treat inflammatory arthritis, and short-term curative effect is obvious, but due to large long-term side effects, the method is not recommended now. Intra-articular injection of analgesic drugs and other drugs have both advantages complications. The efficacy of intra-articular injection drugs in orthopedics is obvious;meanwhile, this method has some complications. Orthopedic surgeons should select related drugs by indications. We stil need to further make reasonable regimen with intra-articular injection drugs in future large-scale study.

BACKGROUND:Tranexamic acid has been more and more used in reducing bleeding after joint replacement, but its usage method and dosage remain controversial, and become a hot focus in recent years. OBJECTIVE:To investigate the efficacy of intra-articular injection of tranexamic acid on postoperative blood loss and limb circumference changes in patients who received unilateral total knee arthroplasty. METHODS:From March to October 2013, clinical data of 90 patients undergoing primary unilateral total knee arthroplasty were randomized to the tranexamic acid group and the control group, including 19 males and 71 females. The 30 patients in the tranexamic acid group received 50 mL of 3%tranexamic acid dilute solution inside knee joint after capsule closure, and 60 patients in the control group received the same volume of physiological saline. No significant difference in age, height, body mass index, anticoagulation, the type of prosthesis, tourniquet time and preoperative diagnosis was detected between the two groups (P>0.05). The amounts of intraoperative and postoperative blood loss and blood transfusion, postoperative drainage volume, the preoperative and postoperative limb circumference 10 cm above the operated knee were recorded. Routine blood test was reviewed after the surgery. RESULTS AND CONCLUSION:There were no significant differences in total blood loss, postoperative drainage volume and limb circumference changes between tranexamic acid and control groups (P>0.05). The amount of postoperative hidden blood loss was significantly less in the tranexamic acid group than in the control group (t=-2.683, P<0.05). These data suggested that the intra-articular injection of tranexamic acid intraoperatively in patients receiving total knee arthroplasty could significantly reduce the amounts of postoperative hidden blood loss, and did not affect the postoperative limb circumference changes.

Objective To evaluate the activation of premotor area (PMA) in verb generation task, and to discuss the possible function of PMA in language expression. Methods Block-designed fMRI with verb generation task was performed on 23 subjects with GE 1.5T MR Scanner. During the test, the subjects were asked to generate a verb based on a given noun word. The white + appeared on the center of the black screen was used as control. The fMRI data were processed with SPM 2. Group analysis was performed with single sample t-test. Average mapping was obtained and overlapped onto standard MNI template. Activation of the PMA was analyzed. Results The fMRI data of eleven subjects were selected for group analysis after head motion effect was ruled out. Average mapping showed activation in the Broca's area, posterior part of the right inferior frontal gyrus, bilateral PMA and supplemental areas (SMA), left posterior parietal cortex, right thalamus, left basal ganglions, right cerebellum, and posterior part of the right temporal lobe. The area with the greatest activated intensity in the brain was the left PMA. Conclusion PMC is important in verb generation and may be responsible for voice processing, motor imagery, word extracting as well as advanced regulation of information.

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 detect the correlation of the expression of microvessel density(MVD) and vascular endothelial growth factor (VEGF) with the semi-quantivative indices of susceptibility weighted imaging(SWI) and perfusion imaging (PI)in astrocytic tumor.Methods SWI and PI were performed in 98 patients with varing grades of astrocytic tumors.According to the World Health Organization (WHO) classification of central nervous system tumors and grading criteria:8 cases of pilocytic astrocytoma (grade Ⅰ,1 case of pleomorphic xanthoastrocytoma (grade Ⅱ),23 cases of astrocytoma (grade Ⅱ),22 cases of anaplastic astrocytoma (grade Ⅲ) and 44 cases of glioblastoma (grade Ⅳ) were included.Intra-tumor susceptibility hypo intensity area (ITSHIA) acquired by SWI was observed and semi-quantitative data were calculated.Maximum relative rCBV values of solid part of the tumor (rCBVintra),surrounding area of tumor (rCBVperi) were calculated.The MVD and VEGF expression were quantified from the excised tumor tissues and were correlated with PI and SWI indices.Kruskal-Wallis H test was used to assess the difference of the MVD and VEGF in different grade astrocytic tumor.Results The MVD count (r =0.550,P ＜ 0.01) and VEGF expression(r =0.456,P ＜ 0.01) were positively correlated with pathologic grading of astrocytic tumor.Spearman correlation analysis indicated that semi-quantivative indictors of SWI (r =0.340 to 0.497,P＜0.01),as well as rCBVintra(r =0.467,P ＜0.01) and rrCBVperi(r =0.374,P ＜0.01)of PI were positively correlated with MVD.All indices of SWI (r =0.202 to 0.334,P ＜ 0.01),except for ITSHIA frequency and ITSHIA area ratio score,were correlated with VEGF expression,while the rCBVintra (r =0.301,P ＜ 0.01) and rCBVperi (r =0.311,P ＜ 0.01) of PI were positively correlated with VEGF.Conclusion The indices of PI and SWI are obviously correlated with MVD and VEGF in astrocytic tumor.PI and SWI could be effective in evaluating angiogenesis preoperatively.

Objective: To localize the functional areas related to music processing with fMRI,and to discuss the possible neural mechanism underlying emotion experience and music therapy.Methods: Thirty healthy non-musicians underwent fMRI study.Experimental tasks included listening passively to instrumental pieces of scale,pleasant classic music and scary music(3 pieces each),which were given in block design.Conjunction analysis was performed with SPM99 to render the mean functional images.Results: Both the pleasant music and the scary music activated the neural substrates underlying affective processing;the former mainly included bilateral lateral prefrontal cortex(left advantage),the left orbitofrontal cortex,the anterior cingulate cortex,the left anterior part of insula,the right thalamus and the left lenticula;the later mainly included bilateral lateral prefrontal cortex(right advantage),bilateral orbitofrontal cortex,bilateral medial frontal gyri,bilateral anterior cingulate cortex and bilateral amygdaloid complex.Conclusion: Passively listening to pleasant and scary music could strongly activate distinct emotion processing substrates,and the positive emotion processing system activation during pleasant music listening may be one of the neural mechanisms of music therapy.