Objective To study the changes of insulin-like growth factor-1(IGF-1) in serum of patients with obstructive jaundice.Methods The clinical data of 20 patients with obstructive jaundice were collected and the measurement of serum TNF-?,ALT, ALP, endotoxin and IGF-1 were performed. Results The serum IGF-1 in obstructive jaundice was significantly lower than that in gallbladder stone(P

Objective To analyze the factors that influence joint function after plate fixation of unstable pelvic fractures.Methods A retrospective study was conducted to analyze the 109 patients with unstable pelvic fracture who had been treated with plate fixation from January 2007 to September 2014.They were 69 men and 40 women,23 to 72 years of age (average,46.3 years).By the Tile classification,15 cases were type B1,37 type B2,14 type B3,19 type C1,16 type C2,and 8 type C3.Their postoperative joint function was evaluated according to the Majeed criteria for functional evaluation.There were 86 cases in the good-to-excellent group (78.9％) and 23 in the fair-to-poor group (21.1％).Their data were analyzed in terms of gender,age,preoperative injury severity scale (ISS),body mass index (BMI),operation time,fracture type,reduction quality,postoperative complications,bone density,and postoperative weight bearing time.The influential factors were determined using Logistic regression analysis.Results All the 109 patients obtained a mean follow-up of 18.7 months (from 12 to 53 months).Preoperative ISS (P =0.000),fracture type (P =0.008),reduction quality (P =0.009) and postoperative complications (P =0.000) were identified as the factors influencing joint function after plate fixation of unstable pelvic fractures.Conclusion Preoperative assessment by ISS,a clear understanding of the pelvic fracture type,anatomical reduction of the fracture and efforts to reduce postoperative complications can effectively improve functional recovery of the joint after plate fixation of unstable pelvic fractures.

ObjectiveTo evaluate the effectiveness of PBL teaching model for medical students in surgery bed side teaching.MethodsThe method of meta-analysis.ResultsFinally,twenty-six documents met the requirement.The resuhs of Meta-analysis showed that,in the aspect of theory improvement for medical students,WMD=6.46,95 ％ CI 为 2.56 ～ 10.36,P＜0.01 ; in the aspect of skill ability improvement,WMD=5.32,95 ％ CI 为 2.47 ～ 8.16,P ＜0.01.ConclusionThe model of PBL teaching could significantly improve the effectiveness in theoretical knowledge and skill ability.

Objective To probe the feasibility of gemstone spectral CT in imaging pulmonary angiography with low dose contrast medium.Methods A prospective study with multi-slice spiral CT pulmonary angiography was performed in consecutive 48 patients suspected with pulmonary embolism.Two groups (n=24 respectively)were divided at random including Group A used Gemstone spectral CT with 35 mL of contrast medium and Group B using 64-slice CT with conventional 80~90 mL of contrast medium.The CT values of the pulmonary trunk,lobe artery,pulmonary vein and ascending aorta were measured.The contrast to noise ratio of the pulmonary artery was also calculated.In addition,the image quality of CTA was evaluated independently by two experienced ra-diologists.Results The CT values of the pulmonary trunk and the subsegmental branches,and the CNR in Group A were signifi-cantly higher than those in group B,exhibiting statistical differences (t=8.6,P <0.001;t=12.2,P <0.001;t=1 1.3,P <0.001 respectively).However,the CT value of aorta in Group A was significantly lower than that in Group B (t=-7.6,P <0.001).The evaluation results of the CTA images by two radiologists showed that the image quality in Group A was better than that in Group B (Z =-8.6,P <0.001;Z =-9.0,P <0.001 ).Conclusion The image quality of pulmonary angiography with gemstone spectral CT using low contrast medium dose can be improved compared with the conventional spiral CT.

Objective To evaluate the feasibility of a low-dose contrast medium protocol for 64-slice CT angiography (CTA) of head using a low-tube-voltage setting.Methods ① Phantom study:64-slice spiral CT respectively sets 80,100,120,140 kV and 100,200,300,400,500 and 600 mA as scanning parameter lines.Analysis of the best Signal-to-noise ratios (SNR) and contrast to noise ratios (CNR).②Clinical study:to prospectively continuous select sixty-six patients with suspected intracranial aneurysm and arteriovenous malformation and so on from April to October of 2012 to perform hand CTA inspection.The random number table method for A,B two groups,33 patients in each group.Group A (conventional group)scanning parameters:120 kV,400 mA and amount of contrast agent:1 ml/kg; Group B(test group) scanning parameters:80 kV,600 mA,amount of contrast agent 0.5 ml/kg.Using independent samples t test for each group radiation dose,SNR,CNR were statistically analyzed.By two experienced radiologists to 5 points on two groups of image quality subjective evaluation.Mann-Whitney U test was used for statistical analysis of subjective evaluation.Results Group A and B group CTDIvol respectively is 59.1,27.5 mGy.Group B than in group A,CTDIvol decreased by 53.5％.A,B groups of the SNR,CNR were 71.5 ± 10.7,92.0 ± 7.4; 58.5 ± 10.5,79.6 ± 7.7,Group B than in group A SNR,CNR were enhanced by 22.3％,26.4％,differences were statistics significance (t =584.0,388.6,P ＜ 0.01).The subjective image evaluation of group B was bigher than group A (Z =31.2,23.4,P ＜ 0.05),differences were statistics significance.Two physicians on CTA images to assess the consistency of uniform height(Kappa =0.904,P ＜0.05).Conclusion In the head CTA examination,use of low tube voltage combined with low contrast dose not only can improve the image quality but also radiation dose were significantly lower.

Objective To evaluate the differences in image quality and radiation dose in the neck CTA between low tube voltage scanning method combined with exact calculation of contrast dosage and conventional scanning methods.Methods Ninety patients who had undergone neck CTA examination from October 2012 to June 2013 were prospectively selected to perform study.Patients were randomly divided into Group A,B and C,each with 30 cases.Tube voltage and contrast amount were,respectively,120 kV and 70-80 ml for Group A (conventional group),100 kV and exact calculation for Group B,80 kV and exact calculation for Group C.Using ANOVA test,radiation dose,contrast amount,CNR were statistically analyzed among three groups.Subjective evaluations were made of image quality by two experienced radiologists based on a 5-point system.Results The effective doses in Group B and C were (4.5 ± 0.7) mSv and (2.1 ± 0.4) mSv,respectively,significantly lower than (6.6 ± 0.9) mSv in Group A,with statistically significant difference(F =72.4,P ＜ 0.05).The amounts of contrast were significantly lower in Group B and C than that in Group A,which respectively were (73.2 ± 8.2) ml for Group A and (48.2 ± 5.1) for Group B and (48.6 ± 5.4) ml for Group C,with statistically significant difference (F =56.8,P ＜ 0.05).CNRs increased respectively by 42.2％ in Group B and by 42.2％ in Group C compared with Group A,with statistically significant difference (F =72.6,P ＜ 0.05).Venous artifact images were found in 10 patients of Group A,having different effects on image quality,whereas in Group B and C,there were not vein artifacts to found.Conclusions The low tube voltage (80 kV) scanning method combined with exact calculation of contrast features not only significantly lower radiation dose and lower contrast amount used,but also improved image quality in comparison with conventional method.

Objective To systematically review the efficacy and safety of drug-eluting stent(DES) versus coronary artery bypass grafting(CABG) in the treatment of left anterior descending coronary artery(CAD) stenosis.Methods Literature about the efficacy and safety of DES versus CABG for LAD stenosis was retrieved from digital databases of MEDLINE, EMbase, PubMed, and the Cochrane Library by November 2016.Data extraction and quality assessment of included studies were conducted by two independent reviewers.RevMan 5.3 software was used to perform meta-analysis.Results Ten studies involving 9771 patients were finally included.The results of meta-analysis showed that there was no significant difference in mortality [RR=0.88,95%CI(0.70,1.11),P=0.28],major adverse cardiovascular events[MACE,RR=1.04,95%CI(0.88,1.24),P=0.63] or myocardial infarction [MI,RR=0.92,95%CI(0.56,1.53),P=0.75], but PCI-DES significantly increased the risk of TVR [OR=2.43,95%CI(1.61,3.69),P<0.0001].Conclusion For LAD stenosis, PCI-DES strategy causes as high a rate of mortality, MACE and MI as CABG or DES, but PCI-DES can significantly increase the risk of TVR, so we should be cautious clinically.

Objective To analyze the correlation factors affecting DSA picture quality and to investigate the DSA value and effectiveness in hepatic arteriography. Methods 36 cases with liver tumor were analyzed through femoral artery intubatton with Seldinger and had hepatic arteriography with RH catheter. Results In the 192 images of 36 cases,the percentage of first-rate image was 92.7%,the second-rate image (9/192) was 5.3%,the third-rate image (5/192) was 2%. Conclusion All of the second-rate images and the third-rate images which were handled with selective image postprocessing can improve picture quality and can reach diagnosis request.

Objective To conduct the molecular epidemiologic analysis of Staphylococcus aureus (S.aureus) in the intensive care units(ICUs) and general wards and to compare their clinical characteristics.Methods Ninety-six clinically isolated strains of S.aureus(43 strains from the emergency intensive care unit(EICU) and neurosurgical intensive care unit(NICU) and 53 strains from the general wards) collected from Sepetember 2015 to April 2016 were performed the bacterial identification and antibiotic susceptibility test.The molecular typing was performed by adopting staphylococcal protein A (spa) typing method.Results Among 96 strains of S.aureus,the detection rate of methicillin-resistant S.aureus(MRSA) was 40.6%(39/96),which among 43 strains in ICU was 62.8%(27/43) and which among 53 strains in the general words was 22.6%(12/53).The resistance rates of strains from ICUs to gentamicin,levofloxacin,clindamycin,fosfomycin and minocycline were 23.3%,48.8%,46.5%,32.6% and 32.5% respectively,while which from the general wards were 7.5%,24.5%,18.9%,2.1% and 0% respectively.The Spa typing results showed that the main types of ICUs were t002,t091 and t311.The major epidemic strain was t002(n=16,37.2%) and mainly isolated from EICUs(12 strains),26 spa types were identified among the general wards trains,mainly were t189,t377,t571,t034,t091,t127.Conclusion The detection rate of MRSA in ICUs is higher than that in the general wards,these strains have high resistant rate to routine antibacterial drugs.t002 is the major epidemic strain.The general wards have more spa types with higher genetic diversity.

OBJECTIVE:To study the bioequiavailability of two sertraline hydrochloride formulations in healthy volunteers.METHODS:A randomized, crossover study of 22 healthy volunteers receiving single oral dose of 50mg sertraline hydrochloride solution(test preparation) or sertraline hydrochloride tablets(comparator preparation) was conducted and the blood concentrations determined by LC/MS/MS.RESULTS: The pharmacokinetic parameters for the test sertraline and the comparator sertraline were as follows:t1/2 were (27.3?5.2)h and (26.3?3.0)h,respectively;Cmax were(9.56?2.49)?g?L-1 and(9.43?2.91)?g?L-1,respectively;tmax were(5.18?1.47)h and(6.00?1.07)h,respectively;AUC0～108 were(329?112)?g?h?L-1 and (297?111)?g?h?L-1,respectively;AUC0～∞ were(354?127)?g?h?L-1 and (316?122)?g?h?L-1,respectively.There were no significant differences in main pharmacokinetics parameters between the 2 preparations,except in tmax from analysis of variance and one-side & two-sides t tests.The relative bioavailability of the test sertraline was(115.5?26.7)%.CONCLUSION:These two sertraline hydrochloride formulations are bioequivalent.