Objective To explore the value of real time contrast-enhanced ultrasound (CEUS) in differential diagnosis of benign and malignant adrenal lesions.Methods Totally,57 adrenal lesions (26malignant and 31 benign) underwent conventional ultrasound and real-time CEUS.The enhancement patterns including types of time-intensity curve,centripetal fill-in,homogeneity and intensity of enhancement were analyzed.Results The enhancement pattern of normal adrenal gland was homogeneous,centrifugal and rapid perfusion from the medulla to the cortex.Four enhancement patterns were significantly different between benign and malignant adrenal lesions (P ＜0.05).If enhancement in the early arterial phase and rapid washout was suggestive of malignancy,the sensitivity and specificity of CEUS were 96.2％ and 77.4％,respectively.If peripheral to central filling was suggestive of malignancy,the sensitivity and specificity of CEUS were 76.9 ％ and 80.7 ％,respectively.Conclusions The patterns of real-time CEUS are helpful in differential diagnosis of malignant and benign adrenal lesions.

Objective To investigate the correlation between insulin resistance with female overactive bladder (OAB) .Meth‐ods 96 female patients with OAB were selected as the observation group and contemporaneous 92 women with healthy physical ex‐amination were taken as the control group .The fasting plasma glucose (FPG) ,triglycerides (TG) ,total cholesterol (TC) ,high‐den‐sity lipoprotein (HDL‐C) ,low‐density lipoprotein (LDL‐C) ,fasting insulin (FINS) ,and C reaction protein (CRP) levels were measured in the two groups .The insulin resistance index was calculated by the homeostasis model assessment of insulin resistance (HOMA‐IR) .Results The waist circumference ,body mass ,body mass index (BMI) ,hypertension cases and proportion of meno‐pause cases in the observation group were higher than those in the control group .FPG ,TG ,FINS ,CRP levels and HOMA‐IR in the observation group were significantly higher than those in the control group ,while the HDL‐C level was lower than that in the con‐trol group .In addition ,the differences in TC and LDL‐C levels between the two groups were not statistically significant (P>0 .05) . Conclusion Insulin resistance has no correlation with female OAB .

Objective To evaluate the color Doppler ultrasonography and contrast enhanced ultrasound (CEUS) findings of congenital intrahepatic portosystemic venous shunts (IPSVS).Methods Nineteen patients of congenital IPSVS were examined with color Doppler ultrasonography and CEUS.All patients were confirmed by CT angiography.The hepatic artery arrival time (HAAT),portal vein arrival time (PVAT),and hepatic vein arrival time (HVAT) on CEUS were recorded.The interval time between hepatic artery arrival time and hepatic vein arrival time (HA-HVTT) and the interval time between portal vein arrival time and hepatic vein arrival time (PV-HVTT) were calculated.Results The types of IPSVS between portal and systemic veins were based on Park's classification.Color Doppler ultrasonography showed abnormal communication between the portal vein branch and the hepatic veins,duplex Doppler ultrasonography showed abnormal spectral pattern from the portal vein such as undulating,triphasic waveform mimicked that of the hepatic vein.CEUS demonstrated abnormal communication between portal vein branch and hepatic vein.HVAT,HA-HVTT,and PV-HVTT were shorter statistically in congenital IPSVS group than those in cirrhosis and normal groups.Conclusions Congenital IPSVS is a rare vascular abnormality that is usually asymptomatic.Color Doppler ultrasonography is a useful tool for diagnosis of congenital IPSVS.CEUS provides helpful data for the diagnosis and differential diagnosis of congenital IPSVS.

BACKGROUND:The selection of metal implant for old patients with femoral intertrochanteric fracture should focus on patient’s age, osteoporotic degree, perioperative status and type of fracture. Individual therapeutic program should be made. OBJECTIVE:To compare the therapeutic effects of four types of metal implant fixation for femoral intertrochanteric fracture in old patients. METHODS:180 old patients with femoral intertrochanteric fractures treated from September 2009 to September 2012 were analyzed. Four kinds of metal implants were used for repair of fracture. There were 45 patients in the dynamic hip screw group, proximal femoral nail anti-rotation group, Gamma nail group and anatomical dynamic hip lock nickelclad group, separately. Operation time, blood loss, hospital time, Harris score after operation, fracture healing time and complications in different groups were compared. RESULTS AND CONCLUSION:Operation time and hospital time were shorter, and blood loss was fewer in the anatomical dynamic hip lock nickelclad group and proximal femoral nail anti-rotation group compared with the dynamic hip screw group and Gamma nail group (P<0.05), but the excellent and good rate of Harris score after operation was higher (P<0.05). No significant difference was detected between anatomical dynamic hip lock nickelclad group and proximal femoral nail anti-rotation group (P>0.05). The incidence of complications was significantly lower in the anatomical dynamic hip lock nickelclad group and proximal femoral nail anti-rotation group compared with the Gamma nail group and dynamic hip screw group (P<0.05). Results suggested that anatomical dynamic hip lock nickelclad and proximal femoral nail anti-rotation are reliable in treatment of intertrochanteric fracture in old patients, show less postoperative complications, and are ideal choices for implant fixation of femoral intertrochanteric fracture in old patients.

Infants with fetal growth restriction (FGR) who did not achieve full in utero growth potential because of environmental factors are at increased risk of morbidity and mortality compared with those with normal in utero growth.Diagnosis and management of FGR are becoming more standardized as clinical guidelines sponsored by academic societies and governments are emerging.However,how to accurately identify FGR fetus and manage the pregnancies appropriately remain controversial.Early prevention of FGR and standardized administration of prenatal glucocorticoids and magnesium sulfate are urgently needed to be addressed with more evidences.

Objective:To evaluate the clinical value of the frozen section assessment of surgical margin in preserving urinary continence and erectile function during robotic radical prostatectomy (RARP).Methods:From Feb. 2022 to Jul 2023, 11 patients underwent RARP using intrafascial dissection technique and frozen section assessment in Beijing United Family Hospital. The median age was 64(61, 69)years, the median PSA was 8.0(6.0, 11.2)ng/ml, and the median IIEF-5 was 17.5(10.3, 22.0). All the patients were diagnosed with prostate cancer and PSMA-PET/CT showed negative for metastasis. The da Vinci Si platform, 4-arm, transabdominal anterior approach was applied in all cases. The prostate specimen was removed from the umbilical incision and submitted to the pathology department for frozen section assessment. If the frozen section assessment showed cancer in the surgical margin, a secondary resection of the ipsilateral periprostatic fascia and neurovascular bundle (NVB) was performed. Totally, 3 cases underwent secondary resection, who underwent unilateral NVB-sparing, and the other 8 cases underwent bilateral NVB-sparing surgery. In follow-up, the PSA, urinary continence and erectile function was assessed and recorded.Results:All the surgeries of 11 cases were successful, without convertion to open surgery. The median operation time was 260(225, 285)minutes, the median blood loss was 200(100, 300)ml, the median hospital stay was 4(3, 5)days. There was no over Clavien Dindo Ⅱ perioperative complications.The median catheter indwelling time was 12(10, 14) days, with 10 cases achieving full continence upon catheter removal. The median follow-up time was 10 months. The median PSA level at 3 months, 6 months and 9 months postoperatively was 0.017(0.006, 0.170)ng/ml, 0.015(0.006, 0.390)ng/ml, and 0.007(0.006, 0.650)ng/ml respectively. The median IIEF-5 at 3 months, 6 months and 9 months postoperatively was 0.017(0.006, 0.170)ng/ml, 0.015(0.006, 0.390)ng/ml, 0.007(0.006, 0.650)ng/ml respectively.The median IIEF-5 at 3 months, 6 months and 9 months post-operation was 5.0(4.5, 11.0), 7.5(4.3, 17.5), and 9.5(6.0, 17.5)respectively.Conclusions:The RARP combined with frozen section assessment of surgical margin has excellent safety profile and can achieve favorable clinical value in tumor control, NVB preserving, urinary continence and erectile function.

Objective To estimate the diagnostic value of cytology, DNA-ICM(DNA-image cytometry),cytology combined with DNA-ICM for pancreatic malignancy,and to explore the cut-off value for DNA-ICM. Methods Patients with suspicious pancreatic malignancy were retrospectively identified. In total,145 EUS-FNA specimens acquired from 140 separate patients were examined by cytology and DNA-ICM. Diagnostic values among cytology, DNA-ICM and the combination of the techniques in detecting pancreatic malignancy were compared. Results Compared with cytology, DNA-ICM had a lower sensitivity (63.0% VS 82.4%)and accuracy(69.7% VS 85.5%). After combining the techniques, the diagnostic value for pancreatic malignancy significantly improved compared with that by cytology(0.941 VS 0.912, P=0.007 0)or DNA-ICM only(0.941 VS 0.815, P<0.000 1). By using the Youden index, the cut-off value for DNA-ICM to detect pancreatic malignancy was one cell with DI(DNA index)≥2.5. Notably,with this standard, the sensitivity and accuracy of DNA-ICM significantly increased to 72.3% and 77.2%, and those of the combined techniques increased to 91.6% and 93.1%, respectively. Conclusion Automated DNA-ICM is an objective and effective method for pancreatic malignancy. Although DNA-ICM has a lower diagnostic value than that of conventional cytology, an improved value was obtained after combining the techniques.

Objective:To evaluate the mixed team-based learning (TBL) teaching method in the practical teaching of critical obstetric diseases.Methods:A total of 72 undergraduate students majoring in "5+3" clinical medicine who practiced in The First Affiliated Hospital of Chongqing Medical University from April to June 2019 were selected in the study. The typical cases of obstetric critical illness were selected, and the students were taught by TBL teaching combined with flipped classroom. After the class, a questionnaire survey was conducted to evaluate the teaching effect.Results:Totally 72 questionnaires were recovered and the results showed that all the students thought this kind of mixed TBL teaching method was helpful to develop clinical thinking ability, and the process of "group discussion" and "extra-curricular preparation" was very helpful to understand the learning. A percentage of 93 (67/72) of the students liked this teaching mode, while 28% (20/72) of the students thought this learning mode was very stressful.Conclusion:This mixed TBL teaching method is effective and feasible in the practical teaching of critical obstetric diseases.

Objective: To understand the current situation and associated factors of myopia in junior middle school students, and to provide scientific basis for prevention and control of myopia in junior middle school students. Methods: A total of 5 393 junior middle school students were selected from middle schools in Guangdong, Guangxi, Guizhou, Liaoning, Shandong, Shanxi provinces. The visual acuity of middle school students was examined, and the data of general population, economy, sociology and natural environment were obtained through statistical yearbook of each province. The influencing factors of myopia of middle school students were analyzed by univariate and multivariate Logistic regression. Results: The results of single factor analysis showed that the myopia rate of junior high school students was different by gender, grades, parents average wage, sunshine duration, temperature, altitude, longitude and latitude(χ2=47.76，59.05，10.79，106.19，53.56，85.02，76.23，107.07，P<0.05). The results of multi factor analysis showed that gender, grade, average wage, temperature and latitude was positively associated with myopia vision; sunshine duration and longitude were negatively associated with the risk for myopia(OR=1.54，1.34，1.62，7.58，27.10，0.42，0.39，P<0.05). Conclusion The myopia of junior high school students is affected by a variety of factors, economic and social factors and natural environmental factors have an impact on the screening of sexual myopia in junior high school students. Economic and social factors and natural environmental factors should be taken into account in the formulation of myopia prevention and control measures.

The anterior cruciate ligament (ACL) injury is a common sports injury that has a significant impact on knee function and patients′ mobility. With the popularity of national fitness campaign in China, the incidence of ACL injury is increasing year by year. Currently, there still lacks clinical standards or guidelines on how to choose appropriate treatment methods, surgical plans and rehabilitation protocols for ACL injury. In order to timely reflect the new treatment concept of ACL injury, standardize its diagnosis and treatment and improve the curative effect, the Sports Medicine Society of Chinese Research Hospital Association and the Editorial Board of Chinese Journal of Trauma organized domestic orthopedic and sports medicine experts to formulate the "clinical evidence-based guideline for the diagnosis and treatment of anterior cruciate ligament injury (2022 version)" based on the level of evidence-based medicine and in compliance with the principle of scientificity, practicability and advancement. The present guideline includes 12 recommendations for the diagnosis, treatment and rehabilitation of ACL injury in order to provide guidance and assistance for the clinical diagnosis and treatment of ACL injury in China.