Objective To discuss the clinical value of three dimensional proton MR spectroscopic imaging( 3D 1HMRSI) in the detection of transition zone(TZ) prorate cancer and evaluate the feasibility of 3D 1HMRSI for determining the aggressiveness of TZ cancer by analyzing its metabolic characteristics.Methods The 3D 1HMRSI data of sixty patients suspected TZ cancer in conventional MR examinations were retrospectively analyzed.The values of (Cho + Cre)/Cit of TZ cancer and benign prostatic hyperplasia (BPH) voxels were recorded and compared using independent sample t' test,and the area under the ROC curve was used to evaluate the diagnostic accuracy.Based on Gleason scores,TZ cancer voxels were divided into three groups,including low-risk ( Gleason score ＜ 7 ),intermediate-risk ( Gleason score =7 ) and highrisk (Gleason score ＞ 7).The values of (Cho + Cre)/Cit were compared among the three groups using Kruskal-Wallis test.The correlation of the value of (Cho + Cre)/Cit and Gleason score was analyzed using rank correlation analysis.Results Among the 60 patients,histopathology confirmed TZ cancer in 25 patients and BPH in 35 patients.The inversion of Cho and Cit peak value with increased ( Cho + Cre)/Cit was detected in 160 out of 177 TZ cancer voxels.Most spectral curves of the 517 BPH voxels were similar with that of normal peripheral zone on 1HMRSI.The mean values of ( Cho + Cre)/Cit of TZ cancer and BPH voxels were 2.17 ± 1.29 and 0.77 ± 0.20,respectively,with significant difference between them( t' =14.38,P ＜ 0.01).Using (Cho + Cre)/Cit for distinguishing TZ cancer,the area under ROC curve was 0.985 (P ＜ 0.01).With the cut-off point 1.08,the sensitivity,specificity and accuracy of TZ cancer diagnosis was 92.7％,94.2％ and 93.8％,respectively.The number of low-risk,intermediate-risk and high-risk TZ cancer voxels were 57,64 and 56 respectively,and the mean values of ( Cho + Cre)/Cit of the three groups were 1.43 ( 1.16-1.87 ),1.66 ( 1.43-2.36 ) and 2.32 ( 1.86-3.30 ) respectively,with significant difference among them ( x2 =36.282,P ＜ 0.01).The value of ( Cho + Cre )/Cit of TZ cancer increased with the increasing of Gleason score with positive correlation ( r =0.555,P ＜ 0.01).Conclusions TZ caner has a different metabolic profile from BPH.The value of ( Cho + Cre)/Cit on 3D 1HMRSI could provide useful information for early detection and differentiation TZ cancer from BPH.Besides these,( Cho +Cre)/Cit is also a valuable imaging marker to evaluate the aggressiveness of TZ cancer.

Objective To explore the value of transcranial Doppler ultrasonography (TCD) on diagnosing the cerebral vasospasm (CVS) following subarachnoid hemorrhage (SAH). Methods TCD was used to detect and monitor the cerebral blood flow status to estimate CVS following SAH in 30 cases, then the results of TCD were analyzed by combining with clinical manifestation and SAH severity on CT. Results 17 patients (56.7%) had the evidence of CVS confirmed by TCD, 10 of them were nonsymptomatic and 7 were symptomatic. The incidences of CVS in patients with Fisher grade Ⅲ and Ⅳ were more higher than gradeⅠandⅡ(P

0.05).②The ophthalmic artery showed a significant increase in Vs and PI,RI 1 week postoperatively(P 0.05).Conclusions Two horizontal rectus muscle operations do cause significant hemodynamic changes in the ophthalmic artery 1 week postoperatively,but these changes in the ophthalmic artery revive normal 1 month postoperatively.

Objective [WT5”BZ] To evaluate the surgical treatment of insulinomas in the head and neck of the pancreas. [WT5”HZ]Methods [WT5”BZ] Data of 43 patients with insulinomas located in the head and neck of the pancreas during the past 16 years in PUMC Hospital were analyzed retrospectively.[WT5”HZ] Results [WT5”BZ] The average age of patients was 37 years old with an average preoperative history of 2 7 years. The preoperative accuracy of PTPC, DSA, B ultrasound, CT and MRI were 89 5%,72 5%,22 4%,25 3% and 66 7% respectively. The accuracy of intraoperative palpation was 97 8%. Enucleation of tumors was usually applied, and distal pancreatectomy or Roux en Y pancreaticojejunostomy were performed in 7 cases. The incidence of postoperative pancreatic leakage was 32 6%.[WT5”HZ] Conclusions [WT5”BZ] Selection of operation methods depends on the relationship of tumor with pancreatic duct and bile duct. Intraoperative monitoring of blood glucose is an essential mean to verify the complete resection of tumors. [WT5”HZ]

Objective To analyze the oral glucose tolerance test (OGTT) curve characteristics in Chinese women with gestational diabetes mellitus (GDM) or gestational impaired glucose test (GIGT) and to evaluate whether omission of the third-hour plasma glucose measurement of the OGTT could alter the sensitivity of the diagnosis on GDM,and whether there is a close relationship between plasma glucose values of 50 g glucose challenge test (50 g GCT) or OGTT and insulin therapy. Methods A retrospective analysis on medical records of 647 cases with GDM from January 1,1989 to December 31,2002 and 233 cases with GIGT were performed. Among 647 cases of GDM,535 were diagnosed by 75g OGTT. All OGTT (535 with GDM and 233 with GIGT) results were evaluated. Results There were 112 cases of GDM diagnosed by elevated fasting plasma glucose without OGTT performed. Of 535 cases of GDM diagnosed by OGTT,49.2% (263/535) women were with fasting plasma glucose value ≥5.8 mmol/L;90.1% (482/535) women with 1hr plasma glucose values ≥ 10. 6 mmol/L;64.7% (359/535) were with 2 hr plasma glucose levels ≥9.2 mmol/L. There were only 114 cases (21.3%) with abnormal 3 hr plasma glucose levels among 535 women with OGTT,and when 3 hr plasma glucose reached cutoff value,49.1% the other three values of OGTT were abnormal and 34.2% with the other two values of OGTT. Among 233 women with GIGT,only 4 cases with the abnormal 3 hr plasma glucose. We also investigate use of the glucose values for the first 2 hours of OGTT only missed 19 cases of GDM,still discriminated 516 cases. Omission of the third -hour glucose tolerance test value only resulted in failure to diagnose 2.9%(19/647) of GDM cases and 1.72%(4/233) of GIGT cases in Chinese women. Plasma glucose levels ≥11.2 mmol/L following 50 GCT were highly associated with GDM necessitating insulin therapy (75.4%). An elevated fasting plasma glucose level was also associated with insulin therapy (59.7%).Conclusion Omission of the third -hour glucose tolerance test value still yielded a higher sensitivity of 97.1%(628/647) of GDM cases and 98.2%(229/233) of GIGT cases in Chinese women. It is practicable to omit 3-hour post -glucose ingestion value of the OGTT in Chinese women. Plasma glucose levels ≥11.2mmol/L following 50g GCT indicated 75.4% cases of GDM necessitating insulin therapy.

OBJECTIVETo discuss the curative effect of traditional treatment and combination therapy for senile hip fracture.

METHODSUsing prospective methods to choose 300 cases of elderly patients with hip fractures from February 2011 to December 2012, which were randomly divided into comprehensive treatment group and conventional treatment group. After screening, 148 case were in comprehensive treatment group,including 62 males and 86 females with an average age of (78.76 +/- 7.32) years old ranging from 60 to 88; 45 cases were intertrochanteric fracture of femur, 103 cases were fracture of neck of femur; Singh index > or = IV in 74 cases, < IV in 74 cases;preoperative Harris score was 39.90 +/- 2.28. There were 146 cases in conventional treatment group,including 60 males and 86 females with an average age of (80.00 +/- 7.06) years old ranging from 66 to 96; 50 cases were intertrochanteric fracture of femur, 96 cases were fracture of neck of femur; Singh index > or = IV in 75 cases, < IV in 71 cases; preoperative Harris score was 40.10 +/- 2.81. Preoperative general situation,leaving bed time and hospital stay, the incidence of postoperative 12 weeks Singh index > or = IV and DPD/Cr value, Harris score at 12 months after operation and the incidence of fracture again of two groups were observed and compared.

RESULTSIn comprehensive treatment group 140 patients were followed up for 12 to 18 months with an anverage of 14.80 +/- 1.85. In conventional treatment group 132 patients were followed up for 12 to 14 months with an average of 12.75 +/- 0.79. There were no significant differences in age, gender, the classification of fracture, preoperative Harris hip score, preoperative Singh index > or = IV level and DPD/Cr value between the two groups (P > 0.05). Comprehensive treatment group had shorter leaving bed time and hospital stay, smaller postoperative 12 weeks DPD/Cr value and higher postoperative Harris score, higher incidence of postoperative 12 weeks Singh index > or = IV level, lower incidence of fracture again than conventional treatment group, there was statistically significant difference between two groups (P < 0.05).

CONCLUSIONFor the anti-osteoporosis effect, the comprehensive treatment group has more advantage than traditional treatment group in elderly hip fracture, which can further improve the elderly hip fracture treatment and provide the reference of evidence-based medicine cooperate with rehabilitation department.

Aged ; Aged, 80 and over ; Case-Control Studies ; Female ; Hip Fractures ; surgery ; Humans ; Incidence ; Length of Stay ; Male ; Postoperative Complications ; epidemiology ; Prospective Studies

Objective To systematic review bladder tumor antigen(BTA) stat in the diagnosis of bladder cancer. Methods MEDLINE, EMBASE, Cochrane Library, CMCC and CNKI were searched for studies about BTA stat in the diagnosis of bladder cancer. The search strategy was made according to the Collaborative Review Group search strategy. Data were extracted by two reviewers using the designed extraction form. The software MetaDiScl. 4 was used to review management and data analysis. Results Seventy-one relevant studies were searched, of which 20 studies were included with 5929 patients involved and 51 studies were excluded. Heterogeneity (except for threshold effect) was found within these studies. A meta-analysis was performed using random effect model. Pooled accuracy indicators like sensitivity, specificity, positive likelihood ratio (LR), negative LR and diagnostic odds ratio (dOR) were 0. 64(95%CI 0. 62-0. 66), 0. 72(95%CI 0. 70-0. 73) , 2. 33(95% CI 2. 03-2. 68), 0. 48(95%CI 0.42 -0.55) and 5.12(95%CI 3. 88-6. 75), respectively. The sensitivity increased with tumor grades. The sensitivity of primary tumors was higher than the recurrent tumors. Area under curve (AUC) of SROC curve was 0. 7500 and Q* index was 0. 6934. Conclusions The performance of urine BTA stat is moderate in the diagnosis of bladder tumor. It can be an optional non-invasive test and an important adjunct test in preoperative detecting and postoperative monitoring of bladder tumor.

Objective To investigate the application of respiratory navigator echo triggered black blood contrast FSE in cardiac MRI. Methods The respiratory navigator echo trigger technique combining with black blood FSE (NAV-FSE) was tested on 11 volunteers and 5 patients in free breathing,using breath-hold FSE (BH-FSE) with the same imaging protocals as control. The imaging efficiency and the image sharpness were compared between NAV-FSE and BH-FSE and t-test was used for the statistics. Results All NAV-FSE acquisitions were completed in sixteen subjects while 4 BH-FSE acquisitions failed because of poor breath holding. The efficiencies of NAV-FSE were (42. 95±11.50)%, (56. 14±11.40)% and (55.25± 14. 70)% when echo train length (ETL) were 24, 16 and 8, respectively. When ETL were 16 and 24, the sharpness of NAV-FSE ( 0. 43±0. 02 vs 0. 36±0. 02 ) and BH-FSE ( 0. 36±0. 03 vs 0. 35±0. 02 ) were statistically different (t =4. 26, 5. 53 ,respectively; P <0. 05). NAV-FSE could have a shorter ETL setting without consideration of breath holding. Conclusion The navigator echo trigger technique could be compatible with black blood contrast FSE to image the heart without the restriction of breath holding and it allows to optimize the parameters to improve the image quality.

The authors probed systematically into the delicacy management measures adopted by the hospital in its internal mechanism reform, innovative medical service model, human resource optimization, and its performance appraisal system reform. Discussions in the paper include such topics as flat management for hospitals,intensification,centralization and integration in diagnose and treatment, as well as vertical nursing management, and the outsourced logistic services. The methods and paths to achieve these goals are summarized as “preciseness, accuracy, carefulness, and strictness”.