Objective To evaluate the usefulness of color Doppler ultrasonography in differential diagnosis of cervical lymphadenopathy by depicting the intranodal vascular pattern. Methods One hundred and twenty lymph node lesions in 113 patients who underwent color Doppler flow imaging were grouped as reactive lymphadenitis ( n =25), tuberculosis ( n =14), lymphoma ( n =41), and metastasis ( n =40). The vascular patterns of hilar type, central type, peripheral type and mixed type were assessed. Results Most reactive lymph nodes( 92.0%) and lymphomatous nodes( 75.6%) showed hilar vessels,lymphomatous nodes also frequently demonstrated peripheral vessels( 75.6%).Central vessels or peripheral vessels were frequent in metastatic nodes( 60.0% and 57.5%, respectively).The intranodal vascular distribution in tuberculous nodes was simulated malignant disease. Avascularity was observed in 2 of 25 reactive lymph nodes and 1 of 14 tuberculous nodes. Conclusions Central vessels or peripheral vessels were mainly found in malignant lymphadenopathy,and the presence of hilar vessels is suggestive of benign lymphadenopathy. However, there is overlap of appearance between benign and malignant disease.

Objective] To explore teacher Zhou Zhiying’s clinical experience in treating tinnitus by using the electric acupuncture with Gongxue point to improve the blood flow of posterior circulation. [Method] By following teacher Zhou ’s clinical diagnosis and treatment as well as organizing previous clinical cases, to sum up teacher Zhou’s academic thoughts and clinical experience on tinnitus by acupuncture and moxibustion, and with proven cases. [Result] Teacher Zhou believes that the treatment of tinnitus must first clear etiology, discern the actual situation, and then find right selected acupuncture prescription with acupoints along meridians and sydrome differentiation. Teacher Zhou considers that tinnitus is related to the cerebral circulatory insufficiency. And Gongxue point has the effect of improving the brain circulation, therefore Teacher Zhou uses the methods of needling Gongxue point to improve posterior cerebral circulation in the clinical treatment of tinnitus, so it can improve inner ear microcirculation, and promote the recovery of neurological function and promote inflammation subsided. Coupled with electric acupuncture, moxibustion and acupuncture for reinforcing and reducing ,it will bring about a significant effect.[Conclusion] The clinical treatment by using the electric acupuncture with Gongxue point to improve the blood flow of posterior circulation for tinnitus curative effect is distinct. Teacher Zhou has unique clinical experience on tinnitus which is worthy our deep study and reference.

In the present paper,the authors review progresses of researches on the protective effect of acupuncture in resisting acute myocardial ischemia-reperfusion injury in patients and animals from 1) resisting injury of oxygen-derived free radicals,2) reducing intracellular Ca2+ overload,3) relieving dysfunction of vascular endothelial cells of the myocardium,4) regulating immune functional activity and reducing inflammatory injury,5) reducing cardiocyte apoptosis,6) upregulating the expression of heat shock protein(HSP 70) in the myocardium,and 7) regulating activities of multiple cardiovascular protection factors and intracellular signaling pathways.The abovementioned results are mainly obtained from experimental animal studies.For this reason,the authors hold that the coming researches on acupuncture therapy for cardiovascular disorders should pay more attention to its clinical application,for example,controlled blood-pressure decline induced lower perfusion of the coronary artery,cardiac surgery(percutaneous tranluminal coronary angioplasty,intracardiac operation underdirect vision) etc.

ObjectiveTo investigate the value of ultrasonography in the diagnosis of the papillary thyroid microcarcinoma (PTMC) in patients with Hashimoto’s thyroiditis (HT).MethodsThis retrospective study used data from Ruijin Hospital of Shanghai Jiaotong University of Medicine during November 2012 to December 2013. A total of 111 small thyroid nodules (75 PTMC/36 benign nodules) with 107 HT cases which were pathologically conifrmed were included in this study. The sonographic characteristics of nodules were investigated, including nodule aspect ratio, shape, border, margin, acoustic halo, internal structure, echo level, microcalciifcations, rear acoustic attenuation, vascular pattern and extent of the blood supply and the types of thyroid tissue echogenicity. Chi-square test and Fisher′s exact probability method was used to compare the differences of the sonographic characteristics between the benign nodules and malignant nodules. With surgical pathology as the gold standard, computing the value of ultrasonography in the diagnosis of PTMC with HT, including the sensitivity, speciifcity, diagnostic accuracy, positive predictive value and negative predictive value.ResultsA total of 111 thyroid tiny nodules (75 PTMC/36 benign nodules) with 107 HT cases which were pathologically conifrmed were included in this study. The results showed 111 small thyroid nodules as solid hypoechoic. Four indexes between PTMC and benign nodules had statistical signiifcance, such as margin, microcalciifcations, vascular pattern and extent of the blood supply. The other six indexes between PTMC and benign nodules had no statistical significance, such as aspect ratio, shape, border, acoustic halo, rear acoustic attenuation and the types of thyroid tissue echogenicity. Ultrasound diagnostic accuracy of small tyroid nodules in patients with HT was 74.77% (83/111). The sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value of the ultrasound diagnosis of PTMC were 93.33% (70/75), 36.11% (13/36), 74.77% (83/111), 75.27% (70/93), and 72.22% (13/18), respectively.ConclusionsCompared with general population, some classic ultrasound features became less effective in patients with HT. However, ultrasonography has some differential diagnostic value in these cases.

Objective To explore the pathological basic of some common characteristic of papillary microcarcinoma of thyroid in ultrasound. Methods Totally 117 thyroid papillary microcarcinomas that were completed all thyroid ultrasound examinations before the surgical excisions were collected. Shape, border, internal echogenicity, halo, posterior echogenicity and calciifcation were observed in ultrasound. While the degree of inifltration of the tumor, the tumor’s internal structure as well as calciifcation was observed in pathology. Results IIrregular shape (87.18%, 102/117), unclear border (80.34%, 94/117), hypoechoic (90.60%, 106/117) and microcalciifcations (65.81%, 77/117) were recognized by ultrasound while the main pathological features were invasive growth (93.16%, 109/117), cell components internally (46.15%, 54/117) and calciifcation (56.41%, 66/117). Of the 109 neoplasms which were invasive growth in pathology, 102 (93.58%) nodules presented irregular shape in ultrasound while 91 (77.78%) presented unclear border. All of the 8 neoplasms which were not invasive growth in pathology showed regular shape in ultrasound. Thirteen nodules showed halos in ultrasound, and 8 of them showed visible ifbrous capsule surrounding the mass. Whatever the tumor’s internal structure was, most nodules presented hypoechoic. And the hyperechoic nodules were all found cell components internally. Of the 66 neoplasms which were found calciifcation by microscope, 35 (53.03%) nodules showed calciifcation in ultrasound and 31 (46.97%) did not. And of the 51 neoplasms in which calciifcation were not found by microscope, 42 (82.35%) nodules showed calciifcation in ultrasound and 9 (17.65%%) did not. Conclusions There is no doubt that all the performances of papillary microcarcinoma in ultrasound have bases in pathology. It is helpful to the judgment of a thyroid nodule if we could understand the correlation of performances in ultrasound and pathology.

Objective To assess the enhancement effect of diagnostic ultrasound combined with microbubbles in the generation of endothelial nitric oxide synthase(eNOS)and nitric Oxide(NO)in endothelial cells.Methods Normal cultured human umbilical vein endothelial cells(HUVEC)were divided into blank control group(A group),simple microbubble group(B group),simple ultrasound group(C group)and ultrasound combined with microbubble group(D group).According to different conditions,group D was divided into three sub-groups:different time groups(1 min,5 min,10 min);different machinery index(MI)groups(0.09,0.4,1.0),different microbubble concentration groups(5×10~8/ml,2.5×10~8/ml,1.25×10~8/ml).Cell morpha was observed in the light microscope immediately and 24 h after the intervention,respectively.RT-PCR was used to measure the relative expression of eNOS in cells.NO kit was used to measure the NO Ievels in culture medium.And statistical methods were used to analyse the experimental data.Results NO and eNOS were significantly higher in group D than the other three groups.When MI=1.0,microbubble concentration=2.5×10~8/ml,and irradiation time=10 min,the increase of eNOS and NO in group D was the most obvious.Furthermore,the cell morphology had no significant change in the light microscope immediately and 24 h after the intervention.Conclusions Ultrasound combined with microbubble can increase the generation of eNOS and NO in endothelial cells.

Objective To systematically assess the efficacy and safety of electroacupuncture for trigeminal neuralgia. Method Randomized controlled trials of a electroacupuncture treatment for trigeminal neuralgia were sought by a computer search of CNKI,Wan Fang Data,VIP,CBM,PubMed,EMbas and The Cochrane Library.The retrieval time limit was from March 1996 to March 2016. Two reviewers sifted the literature and extracted data independently according to the inclusion and exclusion criteria andthen assessed the riskofbias of the included literatureusing the Cochrane risk of bias assessment tool.Ameta-analysis was made using RevMan 5.3.Result Finally, 12 articles were included with atotal of 847 subjects.The results ofmeta-analysis showed that the total efficacy rate was higher in the electroacupuncture group than in the control group [OR=4.04,95%CI(2.67, 6.13),P<0.00001].There were no statistically significant differences in the VAS score [MD=﹣0.06,95%CI(﹣0.59, 0.47),P=0.82] and the recurrence rate [OR=0.64,95%CI(0.05,7.45),P=0.54] between the electroacupuncture and control groups.Conclusion The currentlimited evidenceshows that the total efficacy rate fortrigeminal neuralgiais higher in the electroacupuncture group than in the control group.There are no statistically significant differences in the VAS score and the recurrence rate of trigeminal neuralgia between the electroacupuncture and control groups of patients.But the conclusions need more high-qualitytrials for validation owing to the limitation of the sample size of the included studies.

Objective To investigate the consistency of M RI detecting posterior ligamentous complex (PLC) injury associated with thoracolumbar factures.Methods MRI data of 170 cases of thoracolumbar fractures were reviewed retrospectively.Each case underwent MRI around one week postinjury.MRI data were analyzed and compared by three physicians respectively to discuss the consistency in MRI detection of PLC injury and the severity of PLC injury.Results Kappa coefficient was 0.846 between observer 1 and 2,0.768 between observer 1 and 3,and 0.793 between observer 2 and 3.Interobserver reliability was high and overall Kappa coefficient was 0.803.Severity of PLC injury was interrelated with spinal cord nerve injury (P ＜ 0.05).Conclusions Accurate detection of PLC injury in thoracolumbar fractures is beneficial to clear the mechanical stability of the spine.MRI detection of PLC injury is of high consistency and hence deserves wide use.

Objective To study the effects of early application of integrated traditional Chinese medicine (TCM)and western medicine and massage on the incidence and severity of pneumonia and prognosis in the therapeutic course of infants with cytomegalovirus(CMV)infection infantile cholestatic hepatopathy(ICH)accompanied by gastric volvulus(GV). Methods A prospective randomized controlled trial was conducted. 120 infants 1-6 months old with CMV infection ICH and complicated with GV inpatients were divided into treatment group and control group (each,60 cases). The TCM Lidanheji(consisting of artemisiae capillaris 30 g,weeping forsythia 30 g,Chinese goldthread 5 g,prepared rhubarb 5 g,unpeeled root of herbaceous peony 30 g,cassia 5 g,fruit of citron or trifoliate orange 10 g,large-headed atractylodes 10 g,fruit of Chinese magnoliavine 10 g,pangolin scale 3 g and licorice root 5 g)for oral administration or enema and ganciclovir intravenous injection were given to both groups. In the control group,based on the above treatment,postural and diet therapy,prokinetics(domperidone)were given in cases with GV. The massage treatment was only applied for treatment of GV in treatment group. The pneumonia in both groups was treated in accord to the conventional diagnosis and treatment for infantile pneumonia,bronchiolitis,severe pneumonia and the guide and management of infantile community acquired pneumonia. The total number of cases with pneumonia and its severity occurring before and after treatment in the course of the disease,the clinical therapeutic effects of ICH, GV and infantile pneumonia,the clinical physical signs,biochemical indexes and the time of hospitalization were observed and compared between the two groups. Results Compared with control group,after treatment the curative rate and total effective rate of ICH,GV,infant pneumonia in treatment group were significantly higher〔the curative rate of ICH:83.05%(49/59)vs. 71.93%(41/57),total effective rate:96.61%(57/59)vs. 91.23%(52/57);the curative rate of GV:72.88%(43/59)vs. 51.79%(29/56),total effective rate:96.61%(57/59)vs. 78.57%(44/56);the curative rate of infant pneumonia:81.08%(30/37)vs. 67.44%(29/43),total effective rate:100%(37/37)vs. 100%(43/43),P<0.05 or P<0.01〕. In the treatment group,the total number of cases with pneumonia occurring in the therapeutic course and the incidence of severe pneumonia were significantly less than those in the control group〔the occurrence of pneumonia:12 cases vs. 21 cases,the incidence of severe pneumonia:16.67%(2/12) vs. 42.86%(9/21),P<0.05 or P<0.01〕. The enlargement of liver and spleen,the level of total bilirubin(TBil), direct bilirubin(DBil),total bile acids(TBA)and alanine aminotransferase(ALT)in two groups after treatment were significantly lower than those before treatment,the changes being more marked in treatment group(P<0.05 or P<0.01). The time of stay in hospital in treatment group was remarkably shortened(days:21.32±3.26 vs. 27.38±6.09, P<0.05). Conclusion Early interference with combined TCM and western medicine and massage for treatment of infants with CMV infection ICH accompanied by GV can significantly decrease the incidence of pneumonia and its severity occurring in the disease course,therefore this therapeutic method is beneficial to the treatment and prognosis of infants with CMV infection ICH.

Objective To investigate the damage sequence of posterior ligamentous complex (PLC) and its clinical significance in thoracolumbar fracture.Methods Data of 132 patients with spinal fracture evaluated with X-rays,CT and short-tau inversion-recovery (STIR) sequences in MRI were collected prospectively.Fracture morphology was classified using the AO classification.PLC components including interspinous ligament (ISL),supraspinous ligament (SSL),ligamentum flavum (LF) and facet capsules (FC) were assessed and classified as intact,edema,or tear.ISL edema was further subdivided depending on the extension (＞ 50％ or ≤50％).Correlation between MRI signal and AO progressive scale of morphological damage was analyzed.Results AO type A1/A2 fracture associated with only FC distraction.AO type A3 fracture showed additional ISL tear,usually less than 50％,with neither LF nor SSL tear.AO type B1 fracture showed FC distraction,ISL edema or disruption,and low rate of SSL/LF tear,but B2 fracture increased the rate of SSL/LF tear.AO type C fracture showed facet fracture or dislocation and ISL,SSL as well as LF tear.High correlation was found between AO progressive scale and MRI signal (P ＜ 0.01).Conclusions MRI study can well display the PLC damage and damage sequence.MRI correlates with AO progressive scale of morphological damage,which shows a progressive orderly rupture sequence among different PLC components as traumatic forces increase.