Objective To investigate the predictive value of dynamic diffusion tensor imaging(DTI)in the postoperative efficacy of cervical spondylotic myelopathy(CSM)and to determine whether DTI parameters in different positions can be used as predictors of poor neurological prognosis.Methods A total of 105 CSM patients who underwent cervical spine decompression surgery were included.The modified Japanese Orthopedic Association(mJOA)score was used to assess patients'neurological function before surgery and one year after surgery.Patients were divided into two groups based on the recovery rate:the good prognosis group(recovery rate ≥50％)(44 cases)and the poor prognosis group(recovery rate＜50％)(61 cases).Univariate analysis was performed based on patients'clinical characteristics,imaging features and dynamic DTI parameters.Significant variables were subjected to binary logistic regres-sion analysis to identify risk factors for poor postoperative prognosis in CSM patients.Results Univariate analysis results showed significant differences between the two groups in terms of diabetes,number of compression segments,pre-mJOA score,cross-sectional area of the spinal canal at the narrowest location[Area-N(natu-ral),Area-E(extension),Area-F(flexion)],apparent diffusion coefficient(ADC)(ADC-N,ADC-E,ADC-F)and fractional ani-sotropy(FA)(FA-N,FA-E,FA-F)(P＜0.05).Binary logistic regression analysisrevealed that Area-N[odds ratio(OR)0.226;95％confidence interval(CI)0.069-0.732,P=0.013],FA-N(OR 3.028;95％CI 1.12-8.19,P=0.029),Area-E(OR 0.248;95％CI 0.076-0.814,P=0.021),FA-E(OR 4.793;95％CI 1.737-13.228,P=0.002),Area-F(OR 0.288;95％CI 0.095-0.87,P=0.027),FA-F(OR 2.964;95％CI 1.126-7.801,P=0.028)were independent risk factors for poor prognosis.FA-E had significant predictive value for poor prognosis in CSM patients.Conclusion Dynamic DTI can predict the postoperative outcomes in CSM,and FA-E value can serve as an excellent predictor of poor neurological prognosis.

Objective:By demonstrating the performance, experience and practical value of the original " science and technology evaluation" of Fuwai Hospital, it is expected to build the brand of " Fuwai innovative service for science and technology evaluation" and provide a wider social service.Methods:The four-in-one " science and technology evaluation and service system" , which is composed of " standardized local data-base" , " Fuwai Spider Net Map and Spider Track Map evaluation method" , " hierarchy three-level index system" , and " intellectual science and technology evaluation and service system" , is established for efficient evaluation of science and technology.Results:The " science and technology evaluation and service system" has run with benefit in Fuwai Hospital for years.With the multi-factor evaluating feature, it solves the drawbacks of traditional evaluating system, thus improving accuracy of evaluation and helping implementation of national policies.If the system is extended to other hospitals, it would advocate the feature and strength of Fuwai science and technology evaluation system as well as provide pluralistic reference and advice for decision-making departments.Conclusions:Science and technology evaluation is such a systemic work, with all issues of different levels along the whole evaluating process to be considered.Drawbacks exist in the traditional method which depends on a single final score.By the practice of Fuwai Hospital, the innovative " four in one" evaluation system has been validated to be more scientific.

Objective The study built a scientific performance assessing model by using information technology to construct an intelligent reviewing system,in order to provide intelligent and normalized evaluation services for scientific research performance.Methods A comprehensive and novel practical scientific performance reviewing system was established to provide objective evaluation of scientific output,which was based on accumulated experience in Fuwai Hospital and ample discussion by the experts of academic committee.Results Scientific performance assessment service,which carried out by the collaboration of scientific research management department and informational technology center,were including senior professional title self-assessing system,annual scientific research performance assessing system on both the department basis and individual basis.All the service received satisfactory effect making the assessing service from manual to intelligent.It helps the assessment result turn into openness,fairness and justice.The establishment of the intelligent scientific performance assessing system broaden the mind and provide the basis for the further scientific reward self-evaluation,scientific project application conditions filtering,technology professionals intelligent screening,supervising qualification self-evaluation and scientific project self-reviewing etc.Conclusions The establishment of scientific performance reviewing system effectively avoided the subjective influence,provided timely,highly efficient and accurate evaluating service and comparative analysis,enabling the assessment result much more objective and fair.It merits the promotional value.

Objective To investigate the status quo of utilization of chronic disease resources and quality of life in chronic obstructive pulmonary disease (COPD) patients,and explore the correlation between them.Methods A total of 394 patients with COPD were investigated by the general information question,the Chronic Illness Resources Survey and COPD Assessment Test (CAT).Results The CAT score of COPD patients was (21.33 ± 7.14) points.Among 394 COPD patients,63 patients (16.0％) had ideal utilization of chronic disease resources,and 331 patients (84.0％) did not,the highest dimension of each dimension score was 3.33 points for the health care team (interquartile range 2.67-3.67 points),and the lowest score was 1.67 points for the organization (interquartile range 1.00-2.00 points).Except media policy and quality of life were not relevant,all other dimensions were negatively correlated with CAT scores in COPD patients (r=-0.368--0.169,all P＜0.05).Linear regression analysis showed that the factors affecting the quality of life of COPD patients were:health care team,family and friends,individual coping (P＜0.05).Conclusions COPD patients with quality of life and chronic disease resources should be improved,medical staff should pay more attentions to patients in communication and guidance,and encourage the support of family and friends,in particular,pay attentions to patients with poor attitude,thus improving the quality of life of patients.

Objective: To investigate the prevalence of breast and gynecological diseases in female workers in the administrative office and workshop of an automobile part factory, and to provide a basis for promoting the health of female workers. Methods: In March 2015, color ultrasound examination of the breast, uterus, and bilateral adnexa was performed for all female workers, and routine gynecological examination, routine leucorrhea examination, and thinprep liquid-based cytology test were performed for married female workers. The detection rates of breast and gynecological diseases in female workers in the administrative office and workshop were analyzed. Results: In the 314 female workers, the overall detection rate of breast and gynecological diseases was 86.31%; the detection rate of abnormal breast ultrasound results was 72.93%, mainly breast hyperplasia; the detection rate of abnormal gynecological ultrasound results was 12.14%, mainly hysteromyoma, pelvic effusion, and uterus-rectum fossa effusion. The overall detection rate of cervicitis or vaginitis in married female workers was 66.86%. The univariate analysis showed that compared with those in the administrative office, the female workers in the workshop had significantly higher detection rates of breast hyperplasia and grade 2 breast lesions on the Breast Imaging-Reporting and Data System (BI-RADS) and significantly lower detection rates of hysteromyoma and grade 3 breast lesions on the BI-RADS (all P <0.05) . The multivariate analysis showed that age was a risk factor for hysteromyoma (OR=1.261) , age and working in the workshop were risk factors for breast hyperplasia (OR=1.065 and 1.834) , married status was a protective factor against breast hyperplasia and grade 2 breast lesions on the BI-RADS (OR=0.334 and 0.450) , and working in workshop was a risk factor for grade 2 breast lesions on the BI-RADS (OR=1.890) and a protective factor against grade 3 breast lesions on the BI-RADS (OR=0.355) . Conclusion Female workers in an automobile part factory have high prevalence rates of breast and gynecological diseases. Night shifts for female workers in the workshop should be reduced as much as possible, and female workers, especially those in the administrative office, should be guided to release pressure and take a balanced diet.

[Summary] A total of 128 individuals with type 2 diabetes underwent continuous glucose monitoring for 3 consecutive days.The dawn phenomenon was defined by three different parameters according to the previous research:(1)the absolute increase of glucose level from nocturnal nadir to prebreakfast value(?G) above 20 mg/dl;(2)?G above 10 mg/dl;( 3 ) insulin requirement increased at least 20%.The participants were secondarily separated by presence/absence of a dawn phenomenon based on the definitions above.The impact on blood glucose fluctuation of different groups was assessed according to the standard deviation of blood glucose( SDBG) , the area under curve above 10 mmol/L ( AUC ) , and the mean amplitude of glycemic excursions ( MAGE ) , etc.The frequencies of dawn phenomenon were 64.8%(?G≥20mg/dl), 85.2%(?G≥10 mg/dl), and 59.4%(rise in insulin requirement≥20%)respectively.The impacts on SDBG, AUC, MAGE, and MODD were without statistical difference(P>0.05) between the presence and absence of the dawn phenomenon patients when?G≥10 mg/dl.However, the differences reached statistical significance(P<0.05) when ?G≥20 mg/dl and the increase in insulin requirement≥20%. Besides, the incidence of dawn phenomenon was positively correlated with HOMA-IR, HbA1C , and free C-peptide.Dawn phenomenon is a very frequent event in type 2 diabetes and not only impacts the overall glycemic control but also exaggerates glucose fluctuation.To be clinically relevant, ?G≥20mg/dl should be taken as the quantitative criterion of the dawn phenomenon.

BACKGROUNDVon Hippel-Lindau (VHL) disease is a hereditary tumor disorder caused by mutations or deletions of the VHL gene. Few studies have documented the clinical phenotype and genetic basis of the occurrence of VHL disease in China. This study armed to present clinical and genetic analyses of VHL within a five-generation VHL family from Northwestern China, and summarize the VHL mutations and clinical characteristics of Chinese families with VHL according to previous studies.

METHODSAn epidemiological investigation of family members was done to collect the general information. A retrospective study of clinical VHL cases was launched to collect the relative clinical data. Genetic linkage and haplotype analysis were used to make sure the linkage of VHL to disease in this family. The VHL gene screening was performed by directly analyzing DNA sequence output. At last, we summarized the VHL gene mutation in China by the literature review.

RESULTSA five-generation North-western Chinese family afflicted with VHL disease was traced in this research. The family consisted of 38 living family members, of whom nine were affected. The individuals afflicted with VHL exhibited multi-organ tumors that included pheochromocytomas (8), central nervous system hemangioblastomas (3), pancreatic endocrine tumors (2), pancreatic cysts (3), renal cysts (4), and paragangliomas (2). A linkage analysis resulted in a high maximal LOD score of 8.26 (theta = 0.0) for the marker D3S1263, which is in the same chromosome region as VHL. Sequence analysis resulted in the identification of a functional C>T transition mutation (c. 499 C>T, p.R167W) located in exon 3 of the 167 th codon of VHL. All affected individuals shared this mutation, whereas the unaffected family members and an additional 100 unrelated healthy individuals did not. To date, 49 mutations have been associated with this disease in Chinese populations. The most frequent VHL mutations in China are p.S65 W, p.N78 S, p.R161Q and p.R167 W.

CONCLUSIONSThe results supported the notion that the genomic sequence that corresponds to the 167 th residue of VHL is a mutational hotspot. Further research is needed to clarify the molecular role of VHL in the development of organ-specific tumors.

Adolescent ; Adult ; Asian Continental Ancestry Group ; China ; Female ; Haplotypes ; genetics ; Humans ; Male ; Middle Aged ; Mutation ; Pedigree ; Retrospective Studies ; Von Hippel-Lindau Tumor Suppressor Protein ; genetics ; Young Adult ; von Hippel-Lindau Disease ; diagnosis ; genetics

Objective To investigate the significance of MTSS1 and E-cadherin expression in upper urinary tract transitional epithelial carcinoma.Methods Paraffin specimens of 60 patients with upper urinary tract transitional epithelial carcinoma between January 2005 and January 2014 were analyzed.At the same time,5 cm normal tissue adjacent to the cancerous tissue specimens in 30 patients were taken for comparison.Immunohistochemical method was used to detect the tissue MTSS1 and E-cadherin expression,and the relationships between their expression with different pathological stage,differentiated degree and lymph node metastasis were analyzed.Results MTSS1 expression rate in normal tissue (100.0％,30/30) was significantly higher than that in cancerous tissue (45.0％,27/60) and there was significant difference (P ＜ 0.05).E-cadherin expression rate in normal tissue (96.7％,29/30) was significantly higher than that in cancerous tissue (41.7％,25/60) and there was significant difference (P ＜ 0.05).The expression of MTSS1 and E-cadherin in different pathological stage,degree and with or without lymph node metastasis had significant difference (P ＜ 0.05).In patients with well differentiated,low TNM stage and no lymph metastasis,MTSS1 and E-cadherin expression rate was higher (P ＜ 0.05).There was no significant correlation between the expression of MTSS 1 and E-cadherin in cancerous tissue (P ＞ 0.05).Conclusion In upper urinary tract transitional cell carcinoma detection of both MTSS1 and E-cadherin has important significance with regards to judging the malignant degree of the tumor,lymph node metastasis and prognosis in patients.

Objective To investigate the level of the clinical nurses' critical thinking disposition and the competence about nursing ethical decision making,and analyze the relationship between them.Methods A total of 359 clinical nurses were recruited by stratified random sampling method.They were investigated with general situation questionnaire,critical thinking disposition inventory-Chinese version (CTDI-CV) and judgment about nursing decisiors(JAND).Results The total score of CTDI-CV was (285.06±26.79),the total score of JAND was(267.91±16.62).The influencing factors of clinical nurses' competence about nursing ethical decision making was education background,ways of obtaining occupational knowledge,training of nursing ethical decision.The clinical nurses' competence about nursing ethical decision making was positively correlated with critical thinking disposition.Conclusions The level of clinical nurses' critical thinking disposition and competence about nursing ethical decision making are medium,in order to improve the level of competence about nursing ethical decision making,both school education and the continue education among hospital should strengthen the training of nurses' critical thinking disposition.

10.3969/j.issn.1007-3969.2013.04.005