Objective To explore the application of contrast-enhanced scoring system in the diagnosis of breast tumor.Methods 249 patients with 260 lesions were examined by elastography and contrastenhanced ultrasound before surgery.All the lesions were scored according to the two different methods.Pathological results were made the golden criteria.The diagnosis accuracy of the two methods were compared.Results There were 145 benign and 115 malignant tumors.The diagnosis accuracy,specificity and sensibility of elastography were 85.0％,88.3％,80.1 ％ respectively.The critical value of contrastenhanced ultrasound was between 3 and 4.The diagnosis accuracy,specificity and sensibility of contrastenhanced ultrasound were 88.9％,87.6％,90.4％ respectively.Area under ROC curve of the two methods were 0.901 and 0.910,the difference was not statistically significant.Conclusions Contrast-enhanced ultrasound 5-point scoring system was an initial quantitative criterion for breast tumor diagnosis.The diagnosis accuracy was parallel to that of elastography.

Objective To explore the value of improved elasticity scores in differentiating malignant and benign breast lesions. Methods A prospective study was done in 394 patients with 508 breast lesions confirmed by pathology and the elastographic images of the lesions were evaluated by using old and improved elasticity scores respectively. Results The elastographic images of the lesions could be evaluated and classified in all patients by improved elasticity scores but could not be evaluated and classified in 82 lesions by old elasticity scores. The accuracy of ultrasonic elastography for diagnosing benign and malignant breast lesions was 88.8% and 78.1%, respectively by old elasticity scores and improved elasticity scores. Conclusions The elastographic images of breast lesions were accurately evaluated by using improved elasticity scores, and the use of improved elasticity scores is helpful to reduce the biopsy which is not necessary.

Objective To investigate the changing of endothelial progenitor cells and nitric oxide in patients with pulmonary arterial hypertension secondary to chronic obstructive pulmonary disease.Method Mononuclear cells from 20 healthy persons (the control group, n = 20) , COPD patients without PAH (COPD non-PAH group, n =30) and patients with PAH secondary to COPD (COPD and PAH group, n=30) were investigated. Total mononuclear cells were isolated from peripheral blood by Ficoll density gradient centrifugation. EPC number and migration were assayed by colony forming unit-EPCs (CFU-EPCs) assay and modified Boyden chamber assay , respectively. EPC adhesion assay was performed by replanting those on fibronectin-coated dishes , then adherent cells were counted. The concentration of NO was measured with method of nitrate reductase.Result The numbers of CFU and migration, adhesion activity of circulating EPCs in COPD[ (21.9±3. 9)CFU-EPC] and PAH group[ (14. 2 ±3. 5)CFU-EPC] were significantly lower than that in non-COPD group and COPD non-PAH group [ ( 24.9 ±4.1) CFU-EPC ]. It was also observed that a strong negative correlation between the levels of PAH and the numbers of CFU and adhesion, migration activity of circulating EPCs. The NO level in the PAH group [ (43. 6 ±4. 8)ng/ml] was significantly lower than that in control group [ ( 67. 17±4.9 ) ng/ml ] ( P < 0.01). The NO level was positively correlated with number and migration ability of EPCs( r =0. 77,0.71, P <0.01) , but not correlated with adhesion ability.Conclusion The number of CFU and migratory, adhesive activity of EPC in patients withPAH secondary to COPD was significantly decreased. These changes may be associated with low level of plasma NO.

Objective To investigate the influence of early hyperbaric oxygen (HBO) therapy on cerebral edema and neural function in patients after minimally invasive surgery for intracerebral hemorrhage (ICH).Methods A random number table was used to divide 148 ICH surgery patients into a control group (n =75) and a treatment group (n =73).In the treatment group,HBO was administered in 51 cases 6-24 hours after surgery and then once a day for twenty days.Cerebral edema volume was measured by brain CT before the operation and on the 3rd,7th,14th and 21st day after the surgery.Neurological impairment was scored at the same time points.Results Average cerebral edema volume was significantly smaller in the treatment group than in the control group on the 7th,14th and 21st days,but not on the 3rd day.The neurological impairment scores (NIS) after therapy were significantly lower than that before therapy in both groups.The two groups' average scores were not significantly different before the operation or on the 3rd day,but they were significantly lower in the treatment group thereafter.Conclusion Early HBO therapy can significantly reduce cerebral edema and contribute to nerve functional recovery in patients after minimally invasive ICH surgery.

Objective To provide references for building the medical rehabilitation system in China by learning the progress and compliance of rehabilitation departments construction at tertiary hospitals. Methods Comparative and quantitative methods were used for dynamic analysis qualitative interview to learn the index compliance of the hospitals in question in 201 1-2012.Results Compared with 201 1, average days of stay of the rehabilitation departments declined in general,yet with insufficient therapists;introduction of early rehabilitation intervention was but 57.1%,and the functional assessment rate of rehabilitation service was less than satisfactory.Conclusion Lack of manpower,varying levels of medical rehabilitation services,and neglect for functional assessment were found to be the main problems in construction of medical rehabilitation departments for the time being.

Objective To explore the influence of individualized nursing intervention on life quality of patients with rheumatoid arthritis. Methods 60 patients were divided into the intervention group and the control group with 30 cases in each group. The intervention group adopted individualized nursing projects according to the influencing factors of life quality based on routine nursing. The control group received routine nursing only. The life quality of the two groups was appraised by inventory before and after intervention. Results The status such as physiological function, mental function, social function and self-recognized health in the intervention group was greatly ameliorated and was statistically different from that in the control group(P＜0.05).Conclusion Individualized nursing intervention could dramatically improve the life quality of patients with rheumatoid arthritis

Objective To investigate the diagnostic value of strain ratio for differentiation breast benign and malignant solid lesions. Methods Two hundred and sixty-nine patients with 377 lesions (278 benign, 99 malignant) were included in the study. Ultrasonography found the lesions, then ultrasonic elastography got the strain images. By the strain ratio measure method equipped with the ultrasonic machine, strain ratio of the lesion was calculated. Compared with the pathologic diagnosis, the cut-off point of strain ratio was determined with receiver operating characteristic curve. Results There was significant difference between the strain ratio of benign and malignant lesions( P <0. 05). The cut off point of strain ratio was determined as 3. 08, Youden's index was 0. 88,sensitivity was 97. 38% ,and specificity was 91. 33%. Conclusions Strain ratio could be used to differentiate benign and malignant lesions in breast and would be a new diagnostic standard in future.

Objective To investigate the prognosis and efficiency of glucocorticoid and immunosuppressor in the treatment of idiopathic membranous nephropathy(IMN)in children. Methods A retrospective analysis of 35 cases of biopsy - proven membranous nephropathy without secondary factors was performed,who were found present with ne-phrotic proteinuria and admitted to hospital from March 2004 to July 2013,to explore the efficiency of treatment with glucocorticoid and immunosuppressor and its prognosis. Results The 35 IMN cases included 18 boys and 17 girls,and the ratio was 1. 1∶ 1. 0. The mean age at onset was(11. 3 ± 0. 5)years with a range of 3. 0 - 17. 1 years. Five cases with gross hematuria,24 cases present with microscopic hematuria,8 cases with hypertension,1 case with chronic renal insufficiency,and 2 cases were complicated with thrombosis. According to membranous nephropathy staging criteria,9 cases(25. 7% )were in stage Ⅰ,16 cases(45. 7% )in stage Ⅱ,10 cases(28. 6% )in stage Ⅲ;about 94. 3%(33 / 35 cases)had mesangial cells and mesangial matrix with mild to moderate hyperplasia. They were all treated with glucocor-ticoid initially and one of them showed sensitive to flucocorticoid but developed flucocorticoid resistance after relapse, while all the others were flucocorticoid - resistant. Cyclophosphamide A(CsA)was introduced to 17 cases and at least lasted for 3 months,in which 13 cases(76. 5% )reached complete remission and 3 cases reached partial remission, while 1 case didn't achieve remission,and the mean time for proteinuria to disappear was(4. 9 ± 3. 7)months;5 cases were treated with Mycophenolate mefetil( MMF),among which 4 cases reached complete remission in 2 months,4 months,5 months,and 9 months separately,while 1 case reached partial remission. Cyclophosphamide(CTX)was intro-duced to 6 cases,in which the mean cumulative dosage was(91. 2 ± 46. 5)mg/ kg,among them 1 case(87 mg/ kg) reached complete remission,1 case(160 mg/ kg)partial remission,but 4 cases didn't achieve remission. One case reached remission after Rituximab(RTX)was introduced. One case got partial remission after Leflunomide(LEF)was introduced,and the complete remission rate was higher in those treated with combined therapy of glucocorticoid and CsA than those treated with glucocorticoid only(76. 5% vs 12. 5% ,P = 0. 004),but the total efficacy showed no difference (94. 2% vs 62. 5% ,P = 0. 081). The complete remission rate(76. 5% vs 38. 5% ,P = 0. 042)and total efficacy (94. 1% vs 61. 5% ,P = 0. 040)were higher in those with combined therapy of steroid and CsA than those treated with steroid and other immunosuppressor. The complete remission rate(76. 5% vs 16. 7% ,P = 0. 018)and total efficacy (94. 1% vs 33. 3% ,P = 0. 008)were also higher than those treated with steroid and CTX,but the complete remission rate(76. 5% vs 80. 0% ,P = 0. 687)and total efficacy(94. 1% vs 100. 0% ,P = 0. 773)showed no difference com-pared with those treated with steroid and MMF. Conclusions IMN shows glucocorticoid resistance mostly,while CsA had definite efficiency and may be better than CTX. And the efficiency of MMF should be noted.

Objective To investigate the relationship between folate metabolism-related gene polymorphism and fetal congenital defects,and discuss the effect of genetic factors on fetal congenital defects.Methods Retrospective analysis was used to investigate the genotype and gene frequency of 5,1O-methylenetetrahydrofolate reductase (MTHFR) C677T,A1298C gene loci and ethionine synthase reductase (MTRR) A66G gene locus in 132 cases of adverse pregnancy pregnant women (case group) and 150 cases normal pregnant women (control group) at the same period.The statistical differences were analyzed between the levels of their serum folate,vitamin B12 (Vit B12) and homocysteine (HCY).Results In the serum of case group,folate was positively correlated with Vit B12,and was negatively correlated with HCY,only HCY of skeletal system defects(6 cases) was higher (t =3.409,P ＜ 0.05).Comparing genotypes frequency of the MTHFR C677T,A1298C gene loci and MTRR A66G gene locus in case group with control group,the difference above was not statistically significant (P ＞ 0.05).In these three gene loci C/T,A/C and A/G allele frequency with the control group,the difference above was not statistically significant (all P ＞ 0.05).Different genotype combinations of MTHFR C667T and A1298C gene loci in control groups had no statistically different from the control group (P ＞ 0.05),and there was no synergy.Conclusions Maternal folate metabolism-related MTHFR and MTRR genes polymorphisms can affect the metabolic products levels accordingly.However,the correlation between the changes and the genetic mechanism of fetal congenital defects needs more large samples study in depth.

Objective To evaluate the effect of dexmedetomidine on pulmonary function in elderly patients with mild obstructive ventilatory dysfunction under protective ventilation during laparoseopic gallbladder surgery. Methods Sixty patients were included who underwent laparoseopic gallbladder surgery with general anesthesia. For the all subjects, the age ranged from 65 to 75 years old, the body mass index range was 18.5～23.9 kg/m2, and the ASA grade wasⅡorⅢ. In the subject selection, the gender was not limited, and the included subjects were diagnosed with mild obstructive ventilation dysfunction by preoperative pulmonary function tests. All the subjects were randomly divided into 2 groups (n=30), including dexmedetomidine group (group D) and control group (group C). In the group D, dexmedetomidine was intravenously infused at a dose of 1 μg/kg 10 min before and after the general anesthesia induction, and at a rate of 0.4μg/(kg·h) after tracheal intubation until the end of operation. Group C was given an equal volume of normal saline. Airway peak pressure (Ppeak), mean airway pressure (Pmean), airway plateau pressure (Pplat), and positive end-expiratory pressure (PEEP) were measured at 5 min after intubation (before pneumoperitoneum) (T1), end of pneumoperjtoneum (T2), and 10 min after the end of pneumoperitoneum (T3). The driving pressure (DP) was calculated. The blood samples of the radial artery were collected for blood gas analysis, and PaO2 and PaCO2 were recorded. The oxygenation index (PaO2/FiO2), respiratory index (RI), dead space ventilation rate (VD/VT), and alveolar-arterial oxygen partial pressure difference (A-aDO2) were calculated. The time of removal of the tracheal tube and the occurrences of complications such as hypercapnia and hypoxemia within 48 hours after extubation were recorded. Results Compared with group C, Ppeak, Pmean, DP, RI, VD/VT and A-aDO2 at T1, T2, T3 were decreased in group D, PaO2/FiO2 was increased, postoperative extubation time was shortened, and the incidence of hypoxemia was reduced within 48 h after operation (P<0.05). Compared with T1, Ppeak, Pmean, DP, RI, VD/VT and A-aDO2 at T2 were increased, and PaO2/FiO2 was decreased(P<0.05). Conclusions Dexmedetomidine can improve the pulmonary function in elderly patients with mild obstructive ventilatory dysfunction under protective ventilation during laparoseopic gallbladder surgery.