As the leading cause of death among lung cancer patients, brain metastasis occurs in approximately 10 percent of non-small cell lung cancer (NSCLC) patients at first diagnosis.Whole-brain radiation therapy (WBRT) is still the standard treatment for patients with brain metastasis, however, the efficacy of WBRT reaches a plateau.It has been proved that tyrosine kinase inhibitors (TKIs) make considerable therapeutic effect for NSCLC patients with brain metastasis.The combination therapy of TKIs with WBRT may provide new major treatment for epidermal growth factor receptor (EGFR) mutant NSCLC with brain metastasis.

Objective The purpose of our study is to evaluate high-resolution 3.0 T MRI in the identification of finding in patients with a clinical diagnosis of femoroacetabular impingement (FAI). Methods From June 2008 to May 2010, 54 consecutive patients with clinically diagnostic FAI received an high-resolution 3.0 T MR scan (Siemens AG, Germany), including 38 males and 16 females with an average age of 33.5 years (range, 18-50). All cases were assigned into 3 groups according to the morphology changes of the hip joint: Group Cum, Group Pincer, and Group Normal. The frequency of abnormal signs in 3 groups was calculated. Nonparametric tests by SPSS were used in data analysis. Results Forty-four patients (81.5%, 44/54) showed acetabular labrum disorders, 35 patients (64.8%, 35/54) showed femoral-acetabular cartilage lesions on MRI, 19 patients (35.2%, 19/54) showed arthroedema, 14 patients (25.9%, 14/54) showed femoralacetabular bone disorders, 4 patients (7.4%, 4/54) showed articular capsule and ligaments disorders. There was no statistically significant in the frequency of abnormal sign in MR1 between male and female. The frequency of acetabular labrum disorders, femoral-acetabular cartilage lesions and femoral-acetabular bone lesions in Group Cum was more than that of Group Pincer and Group Normal. The frequency of acetabular labrum disorders was the most disorders (Group Cum 88.5%, Group Pincer 77.8%, Group Normal 70.0%),next high-frequency was acetabular cartilage lesions. Conclusion 3.0 T MRI provides a useful assessment of patients in whom a FAI is clinically diagnosed. A high-resolution, nonarthrographic technique can provide preoperative information. Acetabular labrum disorders and femoral-acetabular cartilage lesions maybe characterized as an earlier period of FAI.

Objective To establish a tissue culture system of Pueraria thomsonii and to cultivate a new breed autotetraploid.Methods Using the MS medium as the basic medium,the explants shoot apexes and stem segments were cultured to differentiate the regenerations.The autotetraloid with genetic material doubled was achieved by treating shoot tips with colchicine of different concentrations for different long times.Results The proper media MS+6-BA 1.0 mg/L + 2,4-D 1.0 mg/L+NAA 0.2 mg/L is for pro-(tocorn) inducing,MS+6-BA 1.0 mg/L+2,4-D 0.2 mg/L for diffrentiation and propagation,and 1/2(MS+) IBA 0.2 mg/L for rooting.The best effect of the autotetraploid induction can be achieved by treating the 0.3-0.5 cm shoot tips cut from the 1 cm plantlets with 0.4%-0.5% colchicine for 48 h,and it is unlikely to succeed by treating shoot tips with colchicine of very low or high concentration or for very long or short time.Conclusion The autotetraploid gives a chance to improve the content of medical materials in the root of P.thomsonii.

The status of health inspection,the setting of courses,teaching reform,requirement of professional and the training pattern of innovative professional were deeply discussed and researched.The pros and cons of several patterns on professional training were summarized.The courses setting and reform emphasis of the innovative professional training were proposed,all of which provided useful view and ideas for training health inspection professionals.

BACKGROUND:The patients receiving total knee arthroplasty are high in average age, and often accompanied with hypertension, diabetes and other basic diseases. Due to the poor physical conditions of the patients,
perioperative hemorrhage becomes the important factor that affecting the safety of replacement.
OBJECTIVE:To analyze perioperative hidden hemorrhage of primary total knee arthroplasty, and to explore the method of evaluating perioperative blood loss by osteoarthritis severity before total knee arthroplasty.
METHODS:A retrospective analysis of 126 knee osteoarthritis patients undergoing total knee arthroplasty was conducted. Al the patients were divided into two groups according to Kel gren and Lawrecne imaging classification:stage Ⅲ group and stage Ⅳ group. The hidden hemorrhage of the patients in two groups was calculated.
RESULTS AND CONCLUSION:The average total blood loss of the patients was 1 560 mL, included hidden hemorrhage 865 mL (55%). The mean blood loss of stage Ⅲ group was 1 290 mL with the mean hidden
hemorrhage of 684 mL (53%). The mean blood loss of stage Ⅳ group was 1 644 mL with the mean hidden
hemorrhage of 921 mL (56%). Statistical analysis showed there were significant differences of total blood loss and hidden hemorrhage between two groups (P<0.05), but there was no significant difference in the percentage of
hidden hemorrhage. The results indicate that higher grade of osteoarthritis imaging classification, the more of total blood loss and hidden hemorrhage, while the change of the percentage of hidden hemorrhage is not significant. Preoperative evaluation of patients’ blood loss by osteoarthritis severity has great significance for blood
management and surgical safety of patients.

Based on the urban residents' basic medical insurance system in Qingdao,with hospitals,community aging care institutions and families as the carriers,Qingdao city explored and implemented the long-term medical care insurance system(LTMCI),and established mechanisms for fundraising,payment,handling,service and supervision.The city also designed a scientific application and reimbursement process.Three service modes are designed and put into practice as follows:Long-term care in designated nursing homes or pension institutions; Medical care at designated hospitals; and home health care.These services are charged by quota-lump per bed per day,with the reimbursement ratio of 96％,90％ and 96％ respectively.A practice over a year proved the LTMCI as effectively alleviating disease burden of patients,and guiding long-term care to serve communities.This way a new type of medical care system comes into being,with medicine-care-recovery-endowment for disabled population.

Objective To evaluate the clinical feasibility of laparoscopic cool-tip radiofrequency ablation (LCRFA)for renal cell carcinoma. Methods Twelve selected cases of primary renal, ceil carcinoma underwent LCRFA. Of them, 4 cases of left renal carcinomas, 7 cases had right renal carci-nomas and 1 case had bilateral renal carcinomas. The maximum diameter of the tumors was 2.1-8. 5 era. Eleven cases were T, No M0 and the other one was T2 N0 M0. Results The mean operation time was 92±24 min, and the mean blood loss was 50±29 ml. None of the cases need blood transfusion post-operation. No laparoscopic operative complications were observed. Six weeks after operation, complete ablation was achieved in 12 lesions and partial ablation in 1, with a complete ablation rate of 92.3%(12/13). There was no statistic change of Hb. ESR. SCr and GFR after operations (P>0.05). Ten cases underwent CT examination 3 months after the treatment ,9 cases showed complete necrosis of tumor,1 case showed partial necrosis. No recurrence was found. All of the 12 cases remained sur-vived during the follow-up for 1-16 months(median,7.8 months). Conelusions LCRFA for renal cell carcinoma is an accurate and effective intervention with a low incidence of complications, and is more accurate than ultrasound-guided pereutaneous radiofrequency ablation.

Objective:To evaluate the value of the crescent sign for predicting the invasiveness of lung adenocarcinoma presenting as pure ground-glass nodule (pGGN).Methods:The clinical, pathological and imaging data of 316 patients (320 pGGNs) confirmed lung adenocarcinoma by surgery and pathology from July 2013 to June 2018 in the First Affiliated Hospital of Wenzhou Medical University were retrospectively analyzed. All pGGNs were divided into preinvasive group (148 pGGNs) and invasive group (172 pGGNs) according to histopathology. Logistic regression analysis was used to determine the risk factors for invasiveness of pGGN, and the ROC curve analysis was performed on each risk factor.Results:Crescent sign was found in 24 cases (16.2%) in the preinvasive group and 49 (28.5%) in the invasive group, and the difference between the two groups was statistically significant (χ2=6.804 ,P=0.009).There were statistically significant differences in patient′s age, lesion size, shape, lobulation sign, and vascular stretch sign between the two groups ( P<0.05). The ROC curve showed that with the lesion size 10.5 mm as the optimal cut off value, the sensitivity for differential diagnosis of preinvasive and invasive lesions was 65.7%, the specificity was 61.5%, and the area under the curve was 0.666. Logistic regression analysis showed that maximum diameter of the lesion ≥10.5 mm, irregular shape, crescent sign and vascular stretch were independent risk factors of invasiveness of pGGN, and the OR value (95%CI) were 3.192 (1.981-5.144), 3.672 (1.545-8.725), 1.972 (1.104-3.521), and 2.026 (1.087-3.777), respectively. A logistic model was established based on the above four independent risk factors, and the area under curve was 0.711 (95%CI 0.655-0.768). Conclusion:Crescent sign can effectively reflect the invasiveness of pGGN. Maximum diameter of the lesion ≥10.5 mm, irregular shape, crescent sign and vascular stretch sign are independent risk factors of invasiveness of pGGN.

Objective To assess the contribution of transrectal realtime tissue elastography (TRTE) on the differential diagnosis of prostatic diseases. Methods A total of 88 prostatic disease patients with 95 lesions proved by pathology from May 2012 to January 2013 in the Afifliated Drum Tower Hospital of Medical College of Nanjing University were included. The elasticity grade and strain ratio were calculated by using TRTE. According to the gold standard of pathological results, the sensitivity, speciifcity, accuracy rate were calculated to evaluate the effectiveness of elasticity grade and strain ratio in distinguishing benign and malignant prostatic diseases;and the receiver operating characteristic (ROC) curves were made respectively. The accuracy of elasticity grade and strain ratio in diagnosing prostatic diseases was also compared using chi-square test. Results Forty-seven benign lesions were found in the 95 prostatic lesions and the other 48 lesions were malignant. The elasticity grades of the 95 prostatic lesions were as follows:GradeⅠ26, GradeⅡ19, GradeⅢ16, GradeⅣ21, and GradeⅤ13. Elasticity grade ≤Ⅱwas considered to be benign, while grade ≥Ⅲwas malignant. The sensitivity, speciifcity, accuracy rate of elasticity grade in diagnosis of prostatic malignant lesions was 79.17%(38/48), 74.47%(35/47) and 76.84%(73/95), respectively. According the ROC curve analysis, the cutoff point of strain ratio was 4.67, and Youden′s index was 0.622. The sensitivity, speciifcity, accuracy rate of strain ratio was 83.33%, 78.72%and 81.05%, respectively. The area under ROC curves of strain ratio was superior to that of elasticity grade. But the diagnosis accuracy of the two approaches was almost the same in statistics (χ2=0.51, P>0.05). Conclusions TRTE is valuable in the differential diagnosis of the prostatic benign and malignant lesions. Both strain ratio and elasticity grade are useful approaches, and have similar diagnostic accuracy.