Objective To explore the evaluation of contrast enhanced CT with multi -direction adjusting multi -planar reformation(MPR)on the stomach wall invasion of advanced gastric cancer.Methods 105 cases of advanced gastric cancer proved by pathology after surgery were checked by contrast enhanced CT before surgery.All the images were reconstructed by multi -direction adjusting MPR to show perfectly the lesions of gastric cancer,T stage diagnosed by CT were compared with the T stage diagnosed by pathology.Results T1,T2,T3,T4 stage diag-nosed by pathology were 9 cases,23 cases,46 cases and 27 cases respectively,the accuracy of multi -direction adjus-ting MPR in diagnosing T1,T2,T3,T4 stage were 98.1%,93.3%,86.7%,91.4% respectively.Conclusion Con-trast enhanced CT with multi -direction adjusting MPR can improve the accuracy in diagnosing the T stage of ad-vanced gastric cancer,which can be used to evaluate the staging of advanced gastric cancer.

Objective To explore the effect of two different position fixing methods on position deviation of different directions and lesions in patients with lung cancer receiving radiotherapy .Methods 100 cases were randomly selected and divided into the two groups .Group A included 50 cases using thermoplastic membrane and group B included 50 cases using vacuum cushion .Position deviations of different directions and lesions of the two groups were observed and compared .Results The forward and backward directions′position deviation of group A was significantly lower than that of group B(t=3.67,P=0.00).The total position deviation of group A was significantly lower than that of group B(t=2.83,P=0.00).The position deviation in the middle of lung field of group A was significantly lower than group B(t =4.26,P=0.00).The repositioning cases of group A accounted for 30.00%(15/50)and group B accounted for 56.00%(28/50).The difference was significant (χ2 =6.90,P=0.00).Conclusion Using thermoplastic membrane as position fixing method in patients with lung cancer receiving radiotherapy can reduce position deviation .

Objective To evaluate the value of computed tomography myelography(CTM)in diagnosing the laceration of brachial plexus. Methods Sixteen cases with brachial plexus injury underwent thin-slice high resolution CT scanning two hours after the examination of conventional lumber puncture myelographs.The results of CTM in patients were compared with surgical exploretation and seven patients underwent preoperatively electrophysiological examination .Results There were totally 28 nerve roots injury.Of them,26 were detected by CTM,the accuracy was 92.8%.The main signs of nerve root laceration were the disapperance of the filling defect of ventral and forsal root,the indirect signs were false meningeal cyst,displacement and deformation of spinal cord,twist of nerve root.Conclusion CT myelography is of significant value in diagnosing the laceration of nerve root.

Objective To explore CT and MRI imaging in the application of newly diagnosed esophageal cancer staging.Methods 200 patients with newly diagnosed esophageal cancer were selected as the research object, who voluntarily accepted the chest CT and MRI examination.Newly diagnosed esophageal cancer pathological results and CT,MRI features were observed.Spiral CT,MRI for T staging of esophageal cancer and N staging diagnosis were compared.Results In 200 patients,including 160 cases of squamous cell carcinoma,30 cases of adenocarcinoma, 10 cases of other types,T1 ,T2 ,T3 and T4 clinical staging period were respectively 19 cases,47 cases,81 cases and 53 cases,while N0 and N1 period were 65 cases and 135 cases respectively.The lesion diameter was 10 -22 (16.5 ± 4.6)mm.CT and MRI showed irregular thickening of the esophageal wall,CT showed equal or slightly lower density, T1 WI was MRI or low signal,T2 WI showed a slightly higher signal.Enhanced scanning,a substantial part of lesion enhancement,while the dead part had no enhancement.In T1 ,T2 of the diagnosis of esophageal carcinoma,MRI had higher diagnostic sensitivity and accuracy compared with CT,and the difference was statistically significant (χ2 =4.32,3.89,all P <0.05).In T3 ,T4 of the diagnosis of esophageal carcinoma,there were no statistical significance of MRI and CT of the diagnostic sensitivity,specificity and accuracy rate difference (P >0.05).By using the joint appli-cation of the two methods,the diagnostic sensitivity and accuracy were significantly higher than that used alone,the difference was statistically significant (χ2 =4.12,3.98,all P <0.05).In the diagnosis of N0 and N1 in esophageal cancer,MRI had a higher sensitivity,there were statistically significant difference compared with CT (χ2 =4.54, 4.23,all P <0.05).The two methods had no significant difference in N0 and N1 phase specific diagnosis of esophage-al cancer and the correct rate (P >0.05).The combined application of MRI and CT significantly improved the diag-nostic sensitivity and accuracy.Compared with the single application,the difference was statistically significant (χ2 =4.32,4.54,all P <0.05).Conclusion MRI is more sensitive to diagnosis T1 ,T2 stage and N0 ,N1 stage in esopha-geal carcinoma.Combined application of MRI and CT can improve the diagnostic sensitivity and accuracy.

Objective To explore the setup errors of two different position fixing techniques in radiotherapy for thoracic canc -er, and analyze and compare the accuracy and repeatability of the two different techniques .Methods Sixty four patients with thoracic cancer were selected in our hospital from December 2011 to June 2013 .All patients received radiotherapy .Patients were divided into two groups by means of random number table .Each group had 32 cases.The low-temperature thermoplastic membrane group used ther-moplastic membrane method to fix position while vacuum bag group with negative pressure fixed position by vacuum bag method .The setup errors in the right/left direction (X-axis), anterior/posterior direction (Z-axis), head/foot direction (Y-axis) and three dimen-sional directions ( I) were compared and analyzed between the two groups .Results The low-temperature thermoplastic membrane group was able to reduce the setup errors significantly in the Z-axis (1.13 ±0.33 /2.33 ±1.24, P <0.05).The differences of setup errors in X-axis, Y-axis and I between the two groups were not significant ( P >0.05).Conclusions Position fixing technique with low-temperature thermoplastic membrane can help to fix position in radiotherapy for thoracic cancer , reduce the setup errors in the Z-axis, and improve the setup accuracy .

Through feedback from questionnaire,relevant problems are summed up,further understanding of the status of medical students' clinical practice is found.then some problems,such as low positivity of students,week didactical consciousness of teachers and inflexibility of practice system,are researched to table some proposals for reformation of clinical practice.

[Objective] To investigate the clinical characteristics and risk factors of lower-extremity arterial disease in the patients with newly diagnosed type 2 diabetes mellitus combined with nonalcoholic fatty liver disease (NAFLD). [Methods] One hundred fifty-one patients were investigated respectively. The patients were divided into two groups (NAFLD-Group and non-NAFLD group) by liver ultrasonography and disease history, then their clinical data were collected and compared in order to find the differences of biochemical indicators and the morbidity of lower-extremity arterial disease between two groups. [Results] Ninety-two cases (60.93%) were complicated with NAFLD. NAFLD group had higher levels of fast insulin and C peptide level, postprandial insulin and C peptide level, uric acid, body mass index (BMI), homeostasis model assessment (HOMA-IR) and lower level of high-density lipoprotein cholesterol and insulin sensitive index than those of without NAFLD (P<0.05). One hundred and one cases(66.89%) were complicated with lower-extremity arterial disease. The morbidity of lower-extremity arterial diseases was higher in NAFLD group than that of without NAFLD group (75% vs. 54.24%, P<0.01). [Conclusion] Both lower-extremity arterial disease and NAFLD are common complicated with type 2 diabetes. The morbidity of lower-extremity arterial diseases was higher in NAFLD group than that of without NAFLD group.

Objective To investigate the relationship between dyslipidemia,obesity,insulin resistance (IR)and various degrees of non.alcoholic fatty liver disease(NAFLD)in patients with type 2 diabetes mellitus (T2DM), and the risk factors of NAFLD.Methods Two hundred and sixty-eight patients were divided into three groups(non-NAFLD group,mild NAFLD group,moderate and severe NAFLD group)by liver ultrasonography.Body height(H),weight(W),waist circumference(WC),hip circumference(H)were measured.The levels of fasting blood glucose (FBG),glycosylated hemoglobin A_1c(GHbA_1C),serum total cholesterol(TC),serunl high density lipoprotein(HDL-C),serum low density lipoprotein(LDL-C),serum triglyceride (TG),alanine aminotransferase (ALT)and fasting serum insulin(FINS)were measured.Body mass index(BMI),the waist to hip ratio(WHR)and insulin resistance index(HOMA-IR)were calculated.Unconditional logistic regression model was used to test for the risk factors of NAFLD.Results BMI、WC、WHR、HNS、HOMA.IR、TC、LDL-C、TG and ALT in NAFLD group were significantly higher than those in non-NAFLD group (P<0.05).The levels of BMI、WC、WHR、HNS、HOMA-IR、 TG and ALT increased significantly in moderate and severe NAFLD group compared with mild NAFLD group(P<0.05).TG、WHR and HOMA.IR were the risk factors of NAFLD(P<0.05,OR=2.394,3.273,5.256).Conclusions NAFLD in patients with T2DM had remarkable dyslipidemia,overweight,central obesity and insulin resistance.TG、WHR and HOMA.IR were risk factors of NAFLD.

Under the guidance of strengthening medical undergraduates' practical ability and their competence in future jobs, Dalian Medical University has established a clinical medical talents practical ability training mode. This model has implementedThree Turnsclinical skills training pattern to strengthen the three stage (before, during and after practice) clinical skills training and concentrated on humanistic quality education through overall evaluations and set up clinical skill examination system to evaluate teach-ing effectiveness comprehensively and truly , which has effectively improved the quality of education by perfecting safeguard mechanisms and guaranteeing teaching quality.

Objective To explore the MRI features about the annular ligament injuries in pediatric patients. Methods The appearance of MRI about annular ligament injuries in 15 pediatric patients diagnosed clinically were retrospectively analyzed. All patients (aged 4 years 8 months to 12 years 11 months) were scanned by MRI in 2-4 days after injury. Patients were divided into three groups according to the annular ligament injuries severity, which were simple annular ligament injuries, annular ligament injuries combined dislocation, annular ligament ruptures combined dislocation. Results Simple annular ligament injuries were showed in 2 cases, which appeared high signal but continuous configuration. Annular ligament injuries combined dislocation were showed 9 cases. Bald head sign, thickening and continuous ligment were found on axial image, together with compression of the radial joint space on sagittal and coronal view. Annular ligament ruptures combined dislocation were showed in 4 cases. The ligment showed"bald head sign", tortuosity and uneven thickening on axial view and compression of the radial joint space on sagittal and coronal view. Combining with the other tissue injuries were detected in 15 cases. Conclusion The annular ligament injuries show some MRI characteristics. Bald head sign is specific in the annular ligament injuries of pediatric patients.