De la intención al comportamiento: modelo analítico del comportamiento de riesgo moral del médico basado en la teoría del comportamiento planificado / From intention to behavior: analytical model of doctor's moral hazard behavior-based on planned behavior theory / Da intenção ao comportamento: modelo analítico do comportamento moral de risco de médicos baseado na teoria do comportamento planejado

Resumen Basado en el concepto de comportamiento de riesgo moral del médico y el modelo teórico de comportamiento planificado, este artículo construye un modelo teórico del comportamiento de riesgo moral del médico y analiza en detalle los principales factores que influyen en el comportamiento de riesgo moral del médico, incluidas las actitudes conductuales, subjetivas normas y control conductual percibido. En combinación con los resultados de la encuesta por cuestionario, este artículo utiliza un modelo de ecuación estructural y un análisis factorial para verificar las hipótesis. Los resultados muestran que en el modelo teórico de la conducta de riesgo moral del médico, las intenciones de riesgo moral de los médicos se ven afectadas por tres variables independientes: actitudes conductuales, normas subjetivas y control conductual percibido. Como variable intermedia, las intenciones de riesgo moral tienen un efecto mediador en el comportamiento de riesgo moral de los médicos. Todos los coeficientes de trayectoria cumplen los requisitos y se verifican todos los supuestos del modelo. El modelo teórico del comportamiento de riesgo moral del médico establecido en este estudio puede explicar eficazmente la ley de ocurrencia del comportamiento de riesgo moral del médico y predecir este comportamiento de acuerdo con la situación real de varios factores influyentes. Esto proporciona una guía teórica eficaz para el siguiente paso para llevar a cabo mejor la investigación relevante sobre el riesgo moral del médico basada en la perspectiva de la gestión, especialmente el establecimiento de estrategias de prevención y control para el comportamiento de riesgo moral del médico.

Abstract Based on the concept of doctor's moral hazard behavior and the theoretical model of planned behavior, this paper constructs a theoretical model of doctor's moral hazard behaviorm and analyzes the main influencing factors of doctor's moral hazard behavior in detail, including behavioral attitudes, subjective norms and perceived behavioral control. Combined with the results of questionnaire survey, this paper uses structural equation model and factor analysis to verify the hypotheses. The results show that in the theoretical model of doctor's moral hazard behavior, doctors' moral risk intentions are affected by three independent variables: behavioral attitudes, subjective norms and perceived behavioral control. As an intermediary variable, moral risk intentions have a mediating effect on doctors' moral hazard behavior. All path coefficients meet the requirements, and all assumptions of the model are verified. The theoretical model of doctor's moral hazard behavior established in this study can effectively explain the occurrence law of doctor's moral hazard behavior and can predict doctor's moral hazard behavior according to the actual situation of various influencing factors. This provides an effective theoretical guidance for the next step to better carry out the relevant research on doctor's moral hazard based on the management perspective, especially the establishment of prevention and control strategies for doctor's moral hazard behavior.

Resumo Baseado no conceito de comportamento moral de risco de médicos e o modelo teórico do comportamento planejado, este artigo constrói um modelo teórico de comportamento de risco moral de médicos e analisa os fatores principais que influenciam o comportamento moral de risco de médicos em detalhes, incluindo atitudes comportamentais, normas subjetivas e controle comportamental percebido. Combinado com os resultados de levantamentos com questionários, esse artigo usa o modelo de equação estrutural e análise fatorial para verificar as hipóteses. Os resultados mostram que no modelo teórico do comportamento de risco moral de médicos, as intenções de risco moral de médicos são afetadas por três variáveis independentes: atitudes comportamentais, normas subjetivas e controle comportamental percebido. Como uma variável intermediária, intenções de risco moral tem um efeito mediador no comportamento de risco moral de médicos. Todos os coeficientes de caminho cumprem os requisitos e todas as suposições do modelo são comprovadas. O modelo teórico do comportamento de risco moral de médicos estabelecidos nesse estudo podem efetivamente explicar a lei de ocorrência do comportamento de risco moral de médicos e pode predizer o comportamento de risco moral de médicos de acordo com a situação real de vários fatores de influência. Isto fornece um guia teórico efetivo para os próximos passos para melhor conduzir pesquisas relevantes sobre risco moral de médicos baseadas na perspectiva de gestão, especialmente o estabelecimento de estratégias de prevenção e controle para o comportamento de risco moral de médicos.

Diagnostic value of ADC histogram based on total tumor volume measurement in prostate cancer / 实用放射学杂志

Objective To investigate the value of ADC histogram of tumor volume measurement in the diagnosis of prostate cancer,and to screen out the best diagnostic parameter value.Methods 31 cases of prostate cancer and 35 cases of benign prostatic hyperplasia confirmed by biopsy or surgical pathology were analyzed retrospectively.DWI examination was performed on all patients before treatment,and b value of 0 and 1500 s/mm2 was selected.The total tumor ADC histogram parameters were measured respectively,including the average value of ADC (ADCmean ),the median ADC (ADCmedian ),the tenth percentile ADC (ADC10th),the twenty-fifth percentile ADC (ADC25th), the fiftieth percentile ADC (ADC50th),the seventy-fifth percentile ADC (ADC75th),the ninetieth percentile ADC (ADC90th), skewness and kurtosis.The histogram parameters of the two groups of patinents and their diagnostic efficacy were analyzed and compared.Results ADCmean ,ADCmedian ,ADC10th,ADC25th,ADC50th,ADC75th and ADC90th in the prostate cancer group were statistically lower than those of benign prostatic hyperplasia group (P <0.01),and there was no significant difference in the skewness and kurtosis between the two groups of diseases (P > 0.05 ).ADCmean ,ADCmedian ,ADC10th,ADC25th,ADC50th,ADC75th and ADC90th diagnosing prostate cancer in the area under ROC curves (AUC)were more than 0.78.ADC10th had the best diagnostic efficacy and its AUC was 0.82, with the optimal cut-off value for 0.27 × 10 -3 mm2/s,with sensitivity and specificity for 78.4％ and 83.3％.Conclusion The ADC histogram of the total tumor volume measurement is of great value in the diagnosis of prostate cancer,among which ADC10th is the most effective parameter.It can accurately distinguish between prostate cancer and prostatic hyperplasia nodules.

CT and MRI features of dermatofibrosarcoma protuberans / 中国医学影像技术

Objective To investigate CT and MRI features of dermatofibrosarcoma protuberans (DFSP).Methods Totally 16 patients with DFSP confirmed by pathology were enrolled.Tumor morphology,CT and MRI imaging appearance (11 cases underwent plain and enhanced CT,5 cases underwent plain and enhanced MRI) were analyzed retrospectively.Results DFSP usually occurred in the skin of truck,head and neck,protruding from the skin surface in different extent.Some lesions even suspended out of the skin.The lesions were divided into nodular type (n=12) and diffuse type (n=4) according to their morphological appearance.The tumors usually demonstrated as iso-density or slightly low density solid mass compared to muscle on CT.On MRI,it usually demonstrated as low signal on T1WI and high signal on T2WI.Tumor blood supply was rich,and it usually showed progressively moderate to strong enhancement.The signs within DFSP include hanging sign (n=2),skin tail sign (n＝6),fascia tail sign (n=l),fat tail sign (n=4).Conclusion DFSP can be characterized by nodular or diffuse lesions,the manifestations of different form are slightly different,but still have a certain characteristic.

A study on impairment of renal function in hydronephrosis monitored byintravoxel incoherent motion MR imaging / 实用放射学杂志

Objective To investigate the value of intravoxel incoherent motion MR imaging (IVIM-MRI)on monitoring impairment of renal function in hydronephrosis.Methods Left hydronephrosis model of Healthy New-Zealand rabbits made by ureteral incomplete obstruction were scanned by IVIM-MRI at 4, 8, 12, and 16 weeks.The change of IVIM-MRI quantitative parameters (ADC values, D values, D* values, and f values) in left hydronephrosis kidney were observed.The correlation between these parameters and glomerular filtration rate (GFR) were evaluated.Results ADC values, D values, D* values and f values at cortex and medulla in left hydronephrosis model of rabbits decreased gradually in the progression of renal damage after 4, 8, 12, and 16 weeks.For D value, f value and ADC values, there was statistical significant difference among the group of 12 weeks, the group of 16 weeks, the control group, and the group of 4 weeks;statistical significant difference was also observed between the group of 8 weeks and the group of 16 weeks by LSD contrast.ADC values, D values, D* values, and f values were positively correlated to GFR at 4, 8, 12, and 16 weeks for left hydronephrosis model of rabbits.Conclusion IVIM-MRI could monitor impairment of renal function in hydronephrosis dynamically.

Imaging diagnosis and clinical analysis of non-HIV infectious penicilliposis marneffei / 实用放射学杂志

Objective To investigate spiral CT,PET/CT and clinical manifestations in non-HIV infectious penicilliposis marneffei lung disease, to improve diagnostic level of this disease.Methods Imaging manifestations of 6 cases of non-HIV infectious penicilliposis marneffei confirmed by bronchofiberscope lung biopsy and/or pus culture were analyzed retrospectively All cases underwent chest CT,two had brain MRI,and two had PET/CT scan before treatment.Imaging appearances were observed and combined with clinical dates and literatures.Results Unilateral lung lesion was detected in 1 case,bilateral lungs lesions in 5 cases.Multiple patchy consolidation,stripe shadow in bilateral lungs or right lung were found in 3 cases, multiple nodes in 2 cases, mass with nodes in 1 case.Among 6 cases, 2 had septa interlobulare thickness,1 had tracheal fistula,2 had pericardium and pleura involvement,4 had bone destruction,1 had the brainand liver involvement.6 cases showed multiple lymphadenectasis,amalgamation and necrosis in bilateral hilar,mediastinaand the neck.2 had abdominal cavity and or retroperitoneal lymphadenectasis.On PET/CT,2 cases showed high uptake,and the range of SUV value were 1.4-13.9.Initial misdiagnosis by imaging was found in 5 cases.6 patients recovered after anti fungus treatment.Conclusion Imaging appearances of non-HIV infectious penicilliposis marneffei mainly reveals as multiple patchy consolidation,nodes and mass in bilateral lungs, all accompany with lymphadenectasis, many with bone destruction,lack of specificity, which needs lesion biopsy and pus culture to make confirmed diagnosis.

Preliminary study of MR elastography for differentiating hepatic focal benign and malignant tumors / 实用放射学杂志

Objective To explore the diagnostic value of MRE for differentiating hepatic benign and malignant tumors.Methods 36 patients with liver tumor (a total of 39 lesions,including 20 hepatocellular carcinomas,7 hemangiomas,5 cholangiocellular carcinomas,3 metastases,2 hepatic angiomyolipomas,1 carcinosarcoma,1 castleman’s disease)and 9 healthy volunteers were evaluated with MRE.The elastogram were generated with FUNCTOOL post processing program.The mean value of elasticity of hepatic malignant tumors,hepatic benign tumors,hepatic parenchyma around the malignant tumors,hepatic parenchyma around the benign tumors and the normal liver of healthy volunteers were measured and compared.Results The mean value of elasticity of malignant tumors [(7.39±1.70)kPa]was significantly higher than these of benign tumors [(4.11±0.37)kPa,P 0.05).A cutoff value of 5.08 kPa can accurately differentiate malignant tumors from benign tumors and normal liver parenchyma.Conclusion MRE could be used in diagnosis of hepatic focal tumors,which is helpful for differentiating benign and malignant liver tumors.

Diagnostic value of ADC histogram based on total tumor volume measurement in prostate cancer / 实用放射学杂志

Objective To investigate the value of ADC histogram of tumor volume measurement in the diagnosis of prostate cancer,and to screen out the best diagnostic parameter value.Methods 31 cases of prostate cancer and 35 cases of benign prostatic hyperplasia confirmed by biopsy or surgical pathology were analyzed retrospectively.DWI examination was performed on all patients before treatment,and b value of 0 and 1500 s/mm2 was selected.The total tumor ADC histogram parameters were measured respectively,including the average value of ADC (ADCmean ),the median ADC (ADCmedian ),the tenth percentile ADC (ADC10th),the twenty-fifth percentile ADC (ADC25th), the fiftieth percentile ADC (ADC50th),the seventy-fifth percentile ADC (ADC75th),the ninetieth percentile ADC (ADC90th), skewness and kurtosis.The histogram parameters of the two groups of patinents and their diagnostic efficacy were analyzed and compared.Results ADCmean ,ADCmedian ,ADC10th,ADC25th,ADC50th,ADC75th and ADC90th in the prostate cancer group were statistically lower than those of benign prostatic hyperplasia group (P <0.01),and there was no significant difference in the skewness and kurtosis between the two groups of diseases (P > 0.05 ).ADCmean ,ADCmedian ,ADC10th,ADC25th,ADC50th,ADC75th and ADC90th diagnosing prostate cancer in the area under ROC curves (AUC)were more than 0.78.ADC10th had the best diagnostic efficacy and its AUC was 0.82, with the optimal cut-off value for 0.27 × 10 -3 mm2/s,with sensitivity and specificity for 78.4％ and 83.3％.Conclusion The ADC histogram of the total tumor volume measurement is of great value in the diagnosis of prostate cancer,among which ADC10th is the most effective parameter.It can accurately distinguish between prostate cancer and prostatic hyperplasia nodules.

Analyzing the relationship between eigenvalues and limb function of rabbit after traction inj ury / 实用放射学杂志

Objective To investigate the correlation between eigenvalues(λ∥ andλ⊥)of sciatic nerve and limb function in a rabbit model of acute nerve traction inj ury for finding the role ofλ∥ andλ⊥ on diagnosis of nerve inj uries.Methods The right sciatic nerves of 32 Newland rabbits were selected to be performed as traction injury,and then left sciatic nerves were treated as control for the sham operation side.MRI DTI scan was performed before and after the operation on 1 day ,3 day,and 1 week,2,3,4,6 and 8 weeks respectively.Theλ∥ andλ⊥ of inj ured sciatic nerves and sham operated nerves were measured,meanwhile functional exami-nations were evaluated,and then analyzing the correlation betweenλ⊥ of inj ured sciatic nerves and the score of inj ured limb function in the periods of 3 days to 8 weeks;finally different portions of sciatic nerve were removed for histological examinations.Results Theλ⊥ of inj ured sciatic nerves in the proximal portion was slightly increased at 3 days and recovered to the normal at 2 weeks.Theλ⊥ of inj ured sciatic nerves in the traction portion and distal portion were slightly raised at 1 day,reached to its maximum value at 3 days,and then decreased gradually after 1 week and dropped to the pre-operation level after 4 weeks.Theλ⊥ of inj ured sciatic nerves in the proximal portions was significantly higher than that of the sham-operated nerves from 1 day to 1 week(F=7.275,P=0.000). Theλ⊥ of inj ured sciatic nerves in the traction portion and distal portion were significantly higher than that of the sham-operated nerves from 1 day to 3 weeks(F=5.851,F=3.794,P=0.001,P=0.000).However,there was no significantly difference between theλ∥ of inj ured nerves in each portion and sham-operated nerves .The negative correlation between theλ⊥ of inj ured sciatic nerves in the distal portion and the score of the nerve function in the injured limb was found (r=-0.938,r=-0.897,P<0.01).Conclu-sion Theλ⊥ of inj ured nerves in the traction portion and distal portion could monitor the process of degeneration and regeneration of sciatic nerve in traction inj ury,while theλ∥ plays no obvious role in diagnosis of nerve inj uries.

Diffusion weighted imaging of lumbar sacral nerve roots in normal and degenerative lumbosacral vertebrae / 实用医学杂志

Objective To explore the characteristics of diffusion weighted imaging (DWI) of lumbar sacral nerve roots (LSNR)in normal and degenerative lumbosacral vertebrae. Methods The research recruited 20 normal volunteers and 31 patients with spinal stenosis on conventional MRI and DWI scans in lumbosacral spine. We measured the areas from lumbar 3 to sacral 1 at the intervertebral spaces and reconstructed the 3D maximum intensity projection (MIP) and counted the apparent diffusion coefficient (ADC)of LSNR and ganglions. Results In the control group, 196 (98%) LSNR ran symmetrically and lateroinferiorly and 200 ganglions were well defined on MIP of DWI. In the patients group, 74 LSNR showed changes of compression on both T1WI and T2WI, in which DWI appeared thin and distorted in 59 (80%). The ADC value of LSNR were(1.70 ± 0.40)× 10-3 mm2/s and(1.98 ± 0.57) × 10-3 mm2/s separately in normal volunteers and patients (P=0.000), while the ADC values of ganglions were(1.42 ± 0.21)× 10-3 mm2/s and (1.54 ± 0.53)× 10-3 mm2/s respectively in normal volunteers and patients (P=0.000). Conclusion DWI can display the pattern and course of LSNR and ganglions, which indicate that ADC values of compressed LSNR and ganglions are higher than normal ones.

Magnetic resonance diffusion tensor imaging of peripheral nerve traction injury and its correlation with histology / 实用医学杂志

Objective To make sciatic nerve traction injury models of rabbit , in order to prospectively evaluate possibility and accuracy of diffusion tensor tracking (DTT) in sciatic nerve injures. Methods The right sciatic nerves of 32 New Zealand white rabbits were selected for traction injury , and the left sciatic nerves were the sham operation side. DTI scan was performed before and after the operation on 1st day , 3rd day, and 1 week, 2, 3, 4, 6 and 8th week respectively, and DTT was reconstructed. Then the length of reconstructed fiber tracts and fiber density index were calculated. After the MRI scan , the sciatic nerve was removed to perform pathologic examination at different time points. Results The difference of the length of reconstructed fiber tracts between nerve traction injury and sham operation side was significant at 1 day~2weeks after operation (P<0.05), while the difference was not significant at 3~8 weeks.The fiber density index of nerve traction injury and sham operation side was significantly different at 1 day~8 weeks(P<0.05). 1day after operation, myelin sheath of traction portion was obviously twisting. 3 days after operation , a large amount of myelin sheath broke down. 2 weeks after operation , axon, myelin sheath degeneration and regeneration coexisted at the same time. 8 weeks after operation , nerve fibers regenerated and restored to normal structure. Conclusion The length time curve and density index-time curve of nerve traction injury are consistent with the changes of pathology , which can be used as a supplementary method to evaluate the degeneration and regeneration in nerve injury.

Preliminary voxel-based morphometry analysis of grey matter abnormalities in early stage of bipolar disorder I / 实用放射学杂志

Objective To estimate brain grey matter volume changes and location of abnormal brain regions cerebrum in early stage of bipolar disorder I (BD),in order to provided objective basis for diagnosing early stages BD.Methods 1 7 cases of BD with duration less than 2 years and 1 7 normal controls were recruited in this study.The volumetric difference of grey matter between two groups were analyzed by using voxel-based morphometry(VBM)software.Statistical threshold was voxel> 100,P <0.001 (uncor-rected).Results Compared to the normal controls,the grey matter volume of BD patients decreased in the left dorcial anterior cingu-late cortex(ACC),left insular,right sub-genu ACC,left superior temporal cortex,bilateral hippocampus-parahippocampus-amydala and left posterior lobe of cerebellum(P <0.001).Conclusion The grey matter volume of early stage BD patients is decreased,main-ly locating in the bilateral limbic system,the superior temporal gyrus and the cerebellar cortex,which probably is the morphological appearance of pathomechanism in early stages of BD.

A study on diffusion-weighted imaging evaluation of levamlodipine treatment in diabetic nephropathy patients accompanied with hypertension / 中国医师杂志

Objective To evaluate the effect of levamlodipine intervention in diabetic nephropathy patients which accompanied with hypertension, using the technology of diffusion-weighted imaging (DWI) of functional magnetic resonance (fMRI).Methods A controlled prospective method was taken , and fifty diabetic nephropathy ( phase III) patients which accompanied with hypertension were randomized assigned to two groups of A ( n =26) and B ( n =24).Levamlodipine (2.5 mg qd) was taken by patients of group A and amlodipine (5 mg qd) was taken by patients of group B for 24 weeks, respectively.Two groups both took angiotensinⅡreceptor blockers (ARBs) as the first line antithypertensive agents , their urinary albumin excretion rate (UAER), serum creatinine (sCr), cystatin C (Cys C) , and DWI scanning were detected before and after intervention .The levels of UAER, apparent diffusion coeffi-cient (ADC) value were compared between two groups before and after intervention .During the 24th week, two groups'adverse reac-tion to the medicines and the levels of blood pressure were recorded in each follow-up visit.Results The levels of UAER, systolic blood pressure(SBP), and diastolic blood pressure(DBP) were Significantly lower in group A after 24-week intervention compared to baseline [42.5 (25.3~91.0)μg/min vs 49.2(29.7~96.8)μg/min,(112.6 ±6.4)mmHg vs (135.3 ±7.6)mmHg, (71.4 ± 10.7)mmHg vs (80.3 ±11.6)mmHg, P 0.05).Group A had a better improvement of SBP (ΔSBP) and ADC (ΔADC) after inter-vention compared to group B ( P =0.02,0.01, respectively).The overall adverse reaction incidence was 15.4%(4/26) in group A and 41.7%(10/24)in group B, respectively (χ2 =4.27, P =0.0387).Conclusions For the diabetic nephropathy (phase III) pa-tients accompanied with hypertension , levamlodipine likely showed better effects on reducing comprehensive blood pressure and UAER , improving renal microcirculation , with less overall adverse reaction compared to amlodipine .

Clinical study on chemotherapy of lobaplatin combined with docetaxel in patients with relapsed ovarian cancer / 中南大学学报(医学版)

Objective: To evaluate the efficacy and safety of lobaplatin combined with docetaxel in the treatment of the recurrent ovarian carcinoma. Methods: We collected 31 patients who diagnosed as recurrent ovarian carcinoma according to the histopathology or cytology from Tumor Hospital of Hunan Province from January 2011 to January 2013. The patients received cisplatin-based chemotherapy or carboplatin-based chemotherapy before the combined chemotherapy of docetaxel and lobaplatin. For patients with the recurrence, they received a treatment at a dose of 80 mg/m2 for docetaxel on day 1 and a dose of 30 mg/m2 for lobaplatin on day 2, which lasted for 21 days as a treatment cycle. hTe patients received 6-cycletreatment at most. Results: A total of 153 cycles of chemotherapy were given to 31 patients, with a median of 4 (2–6) cycles. Three patients showed complete response, 11 partial response, 2 stable disease, and 15 progressive disease. hTe objective response rate (ORR) was 45.16% (95% CI, 26.61%–63.72%), and the disease control rate (DCR) was 51.63% (95% CI, 32.98%–70.25%). The median progression-free survival was 7 months (95% CI, 4.27–9.73 months). For the toxic and side effects among the 31 patients, the numbers of the grade 3, grade 2, and grade 1 leukopenia were 1, 8, and 13, respectively. Meanwhile, 18 were grade 1–2 neutropenia, 17 grade 1–2 anemia, and 2 grade 1 thrombocytopenia. At the same time, alimentary canal reaction followed by nausea and vomiting was relatively modest and could be controlled. hTe serious damage of hepatic-renal function was not found. Conclusion: The chemotherapy of lobaplatin combined with docetaxel is effective on recurrent and refractory ovarian cancer with low side effects, which has advantages over the second-line chemotherapy protocols.

Magnetic resonance diffusion tensor imaging of a sciatic nerve traction injury model and its pathologic correlation / 中国组织工程研究

BACKGROUND:Magnetic resonance diffusion tensor imaging can display the dispersion changes of peripheral nerve injury and be used to conduct quantitative research, so it has good application prospects in displaying the nerve injury and regeneration. OBJECTIVE:To investigate the possibility of magnetic resonance diffusion tensor imaging of rabbit acute sciatic nerve traction injury, and to figure out the value of diffusion tensor parameters in the diagnosis of peripheral nerve injuries and to reveal the pathologic basis. METHODS:The right hind limb sciatic nerves of 32 New Zealand white rabbits were selected to make the regeneration and repair models, the left hind limb nerves as the sham-operation side. Diffusion tensor imaging examination of sciatic nerves were performed at 1 and 3 days, 1, 2, 3, 4, 6 and 8 weeks after operation with 1.5 T MRI. Fractional anisotropy and apparent diffusion coefficient were measured through diffusion tensor tracing reconstruction, and then the pathological examination was performed. RESULTS AND CONCLUSION:Diffusion tensor imaging revealed only the proximal nerve, injured nerve as wel as the middle of the distal nerve at 1 day after traction injury. At 1 week, the nerve of distal portion appeared thinner and shorter fiber bundle. At 2-6 weeks after operation, the fiber bundle was increased and thickened. At 8 weeks after operation, the distal nerve fibers had nearly restored to the level before injury. There was significant difference in the fractional anisotropy value of traction portion and distal portions between traction injury and sham-operation group at 1 day-8 weeks after operation (P<0.05). While there was significant difference in the fractional anisotropy value of proximal traction portion between traction injury and sham-operation group 1 day-1 week after operation (P<0.05). There were no significant differences in the apparent diffusion coefficient values between traction injury and sham-operation group at 1 day-8 weeks after operation. Fal of fractional anisotropy value in the early stage of nerve traction injury was the result of myelin sheath broke down and axonal disintegrated;recovery of fractional anisotropy value resulted from myelin sheath proliferated and myelin sheath grew slowly to mature. Diffusion tensor tracing can show the abnormal change of the sciatic nerve with traction injury in rabbit clearly and early, and the measurement of fractional anisotropy value can be used as the sensitive method to monitor the degeneration and regeneration after nerve traction injury.

Clinical application of TMJ appliance in treatment of obstructive sleep apnea syndrome / 实用口腔医学杂志

6 OSAS patients wore the appliance. Polysomnographic monitoring and cephalometric analysis were performed before and after treatment to analyze the effect of the appliance. With the appliance on after one month, the patients felt better. The values of AHI decreased significantly(P<0.01), and the lowest SaO_2 increased significantly(P<0.01).Cephalometric analysis showed a widened airway(P<0.05)after treatment. The results showed that TMJ appliance is an easy and effective treatment of OSAS.

Total hip replacement with Ribbed hydroxyapatite-coated femoral stem and cup component:a 24 cases report / 中国矫形外科杂志

[Objective]To investigate the long-term result of total hip replacement with a Ribbed hydroxyapatite-coated proximally femoral stem and cup component.[Method]From June 1999 to May 2002,24 cases (26 hips) with hip joint disease received cementless total hip replacement with a Ribbed hydroxyapatite-coated proximally femoral stem and cup component. There were 14 males and 10 females with the average age of 59.4 years. The disorders included avascular necrosis of the femoral head in 13 cases,femoral neck fractures in 9 cases,hip dysplasia in 2 cases. X-ray scans were recorded at 7~10 days,6 month,and every 1 year after operation respectively. Harris score was evaluated at last follow-up for hip joint function evaluation.[Result]According to Harris evaluation,16 cases (18 hips) received 85-100 points,8 cases (8 hips) received 75-84 points. Mild thigh pain happed in 1 case. Slight bone absorption was found in 1 case. No case needed second revision. Six month-3 year postoperative X-ray showed bone absorption in Gruen zone 5,6 and 2,3 near HA coating in 1 case (1 hip). Bone density increase was found in both cancellous and cortical bone,which revealed good prosthesis-bone fixation.[Conclusion]A Ribbed proximally hydroxyapatite-coated femoral stem and cup implant are able to enhance the initial fixation of implants,to accelerate bone in-growth and osseous fixation of the femoral stem and cup component,to seal the interface between the implant and osseous,and to prevent ingress of polyethylene particles which lead to thigh pain and bone absorption. It has showed good long-term results.

Change regulatives of bone mineral density after total ankle arthroplasty:six cases results in connective three years / 中国矫形外科杂志

[Objective] To study the change regulatives of BMD(bone mineral density)in after total ankle arthroplasty.[Methods]From Oct.1997 to Dec.2004,the BMD of the subjects were measured to involve in the study.There were 6 cases(5 male,1 female)with an average of 54.4 years old.Their BMD of the subjects was measured by DEX-A(Lunar)at the tibia and talus of the ankle post-arthroplasty in 6 months,12 months,2 years and 3 years postoperatively.All data were saved in computer and all statistical analyses were performed uaing SPSS 8.0 system in personal computer.[Results]The bone trabecula growing into micropore coated of the prosthesis has been showed on radiograth post-surgeryat average period of 1.5 years to 2 years.In the third year itreached bone mass at the distal tibia and talus of the total ankle replacement,which mean BMD 0.854?0.217 at post operative 6 months,BMD 0.975?0.142 at post operative 12 months,BMD 0.956?0.213 at post operative 2 years,and 1.155?0.210 at 3 years(P

The Application of MR Diffusion-Weighted Imaging and MR Angiography in Transient ischemic Attacks / 实用放射学杂志

Objective To evaluate the value of diffusion-weighted MRI ,time of flight MR angiography (TOF-MRA) and 3D dynamic contrast enhanced MR angiography (3D DCE-MRA) in the diagnosis of transient ischemic attacks(TIA). Methods 176 consecutive patients with TIA were undergone MRI, including FLAIR,DWI,TOF-MRA and 3D CE-MRA sequences. Results Of 176 cases,48.9% of patients were found having hyperacute ischemic lesions by DWI sequence and 18.2% of lesions could be detected by T2WI.TOF-MRA showed arterial stenosis and occlusion in 76 cases(43.2%),false positive rate and excessive diagnosis were happened in 20 cases.3D CE-MRA of brain showed arterial stenosis and occlusion in 69 cases(39.2%).3 cases with aneurysm and 2 cases with arteriovenous malformation were detected by two methods.3D CE-MRA of neck showed arterial stenosis and occlusion in 38 cases(21.6%).Conclusion DWI and MRA are helpful in detecting the hyperacute ischemic lesion and evaluating the arterial lesions in the patients with TIA.

Prospects for and practice in the economic management of hospitals / 中华医院管理杂志

Reviewing the practice in the economic management of hospitals in recent years, analyzing its changes and development tendencies, and identifying the strategies and methods for future development will be beneficial for hospitals to go with the social tide, seize development opportunities, expand advantages and improve management benefit. From a panoramic perspective, the changes and developments of the economic management of hospitals chiefly manifest as transformation in the concepts of operational management, enhancement of its strategic position, expansion of management functions, changes in organizational structures, increasing scientific nature of technical means and improvement of personnels quality. Now that the new century has set in, hospitals hoping to enhance their economic management must exert to constantly update concepts of operational management so as to be adapted to the market of health service under the reform policies. Only by expanding the functions of economic management and making constant innovations in line with hospital reforms can the benefit of economic management be brought into full play. It is necessary to regroup institutions of economic management before a cohesive force can be shaped. It is also a must to cultivate talented personnel in the field of operational management in order to improve management benefit and keep abreast of the development of hospitals in the new century.

Effects of matrix metalloproteinase-12 abnormal expression on the transformation of pulmonary fibroblasts in radiation damaged rats / 解放军医学杂志

Objective To observe the effects of over-expression of matrix metalloproteinase-12 (MMP-12) on the transformation of pulmonary fibroblasts in radiation damaged rats. Methods Thirty-two male Wistar rats (weighed 250-280g) were randomly assigned into control group and 1, 2 and 4 weeks after irradiation groups (8 each). The whole lungs of rats in irradiation groups were irradiated by 60 Co ?-ray at a dose of 20Gy, and the lung specimens were harvested 1, 2 and 4 weeks after radiation. The change of MMP-12 activity was detected by gelatin zymography, the degradation and collapse of elastic fibers were observed by tissue specific staining, the "cross talking" phenomenon between alveolar type Ⅱ cells and mesenchymal cells was observed by transmission electron microscopy, the content of TGF-?1 was determined by ELISA, and the expression of ?-smooth muscle actin (?-SMA) was examined by immunohistochemistry. Results MMP-12 activity began increasing 1 week after irradiation, and seemed to decrease 4 weeks after irradiation. Elastin, a part of the basement membrane of alveolar wall, began to degrade and collapse 1 week after radiation, and became worse 4 weeks after irradiation. The expressions of both TGF-?1 and ?-SMA were elevated gradually within 4 weeks after radiation. The "cross talking" phenomenon was found by electron microscopy between alveolar type Ⅱ cells and mesenchymal cells. Conclusions Increased activity of pulmonary MMP-12 has been found after radiation, which may promote the transformation of pulmonary fibroblasts by degrading elastin and ultimately initiate the pulmonary fibrosis.