Objective:To evaluate the value of 64-slice CT portal venography(CTPV)in demonstrating portal system and its collaterals in portal hypertension.Methods:50 cases of portal hypertension were included in the study and undergone upper abdomen examination with 64-slice CT,image post-processing techniques such as MIP,MPR and VR were applied to display the portosystemic collaterals of portal venous system.Results:CTPV simultaneously depicted fourth or fifth branches of the intrahepatic portal veins and provided images of entire portosystemic collaterals,on CTPV images,left gastric varices were seen in 48 patients(96%),esophygeal and/or fundic varices in 46(92%),paraesophageal varices in 41(82%),shnrt gatric veins or posterior gastric veins in 19(38%),shunt between spleen/gastric-renal vein in 14(28%),abdominal wall and paraumblical varices in 20(40%),retroperitioneal varices in 19(38%),portal sponge degeneration in 8(16%).Conclusion:CTPV can much more clearly demonstrate the collateral vessels in patients with cirrhosis and portal hypertension.An understanding of the varied appearances of acquired abnormalities of the portal venous system will allow more definitive diagnosis and help avoid false diagnosis of disease,and may play a significant role in marking a clinical treatment plan.

Objective:To analyse the findings of MRI and CT in the diagnosis of spine metastases in 52 cases,and compare their sensitivity and specificity,in order to increase the early diagnosis rate of spinal metastases.Methods:The most common sources of skeletal metastases were carcinomas of lung,breast,nasopharynx.MRI and CT were performed in 52 patients with metastatic tumor.The detectability for vertebral metastasis was compared between the two modalities.Results:Of the 52 cases,there were destructions of 176 vertebral bodies,76 lesions of spinal canal involvement,68 paravertebral soft tissue.masses and pathological fractures of 47 vertebral bodies.In the cases of stage Ⅰ spinal metastases:21 were detected by MRI and nothing was detected by CT.In the cases of stage Ⅱspinal metastases:86 were detected by MRI;52 were detected by CT.In the cases of stage Ⅲ spinal metastases:68 were detected by MRI;61 were detected by CT.The sensitivity of spinal metastases by MRI(99.4%) higher than CT(64.2%).MRI demonstrated decreased signal intensity(86.9%)and other abnormal signal intensity(13.1%)on T1WI and increased signal intensity(60.8%)and other abnormal signal intensity(39.2%)on T2WI.Conclusion:The sensitivity and specificity of MRI is higher than that of CT.Two methods are complementary to each other,so MRI combined with CT can improve the sensitivity and accuracy in the diagnosis of spinal metastases.

Non-coding small RNA mainly includes microRNA, small interfering RNA and RNA interacting with PIWI protein.Studies have shown that non-coding small RNA plays an increasingly important role in the epigenetic regulation.Non-coding small RNA is involved in the regulation of gene expression by gene transcription, post-transcription and mRNA translation.Non-coding small RNA is closely related to many human diseases, especially the diagnosis, treatment and prognosis of melanoma.

Objective To analyze the clinical data,radiological and pathological features of breast cancer which were understated by image,and summarize the causes.Methods The clinical features,radiological features and pathological data of 26 cases of breast cancer were retrospectively analyzed.The preoperative ultrasound and mammography BI-RADS grades of these 26 cases were both ≤ 3,and they were confirmed to be breast cancer by pathology.The clinical and pathological data of 1224 cases of breast cancer in the same period were compared.Results For the 26 cases,100％ were early breast cancer,100％ were HER2 negative breast cancer,and only 1 case had lymph node metastasis.26％ were special type of breast cancer.Mammography showed glandular multi type,and ultrasound showed atypical or typical benign features.Conclusions Breast cancer understated by image shows features of young age,early stage,well differentiated,low malignant degree,not easy to be visualized by mammography,and their ultrasound features are usually atypical.In clinical setting,analysis of the ultrasound and mammography images should be combined with other examination,to decrease misdiagnosis rate.

BRAF gene has the highest mutation rate and plays an important role in the occurrence,development,invasion and metastasis of melanoma.The frequency of the mutation varies in different clinical phenotypes,clinical pathology classifications and stages of malignant melanoma,which indicate a certain association of BRAF gene with the growth and prognosis judgment in malignant melanoma.BRAF gene mutation is the new direction of treatment in malignant melanoma molecular target therapy.

Objective To explore the application efficacy of scalp nerve block combined with sevoflurane in craniotomy.Methods Fifty-five patients undergoing craniotomy in pingdingshan second people's hospital of henan province from Mar 2013 to Mar 2015 were randomly divided into observation group (n =28) and control group (n =27).The scalp nerve block combined with sevoflurane was performed in observation group and the sevoflurane intravenous inhalational combined with sufentanil was performed in control group.The changes of MAP and HR were observed before induction,5min after induction,skin incision,break the meninges,operation end and 5rmin after catheter removal.The agitation scale after operation,anesthesia duration,awaking time and dosage of sufentanil were compared.Restults MAP and HR at skin incision,break the meninges,operation end and 5min after catheter removal in control group were significantly increased than those before operation,and significantly higher than those in observation group at same stage of operation,with statistically significance differences (P ＜0.05).The agitation scale of observation group was lower than that of control group,with statistically significance difference (P ＜0.05).There was no significance difference between two groups in anesthesia duration (P＞0.05),the awaking time in observation group was significantly shorter than that in control group and the dosage of sufentanil was significantly reduced in observation group (P＜0.05).Corclusion Scalp nerve block combined with sevoflurane used in craniotomy has advantages in stable vital signs,rapid awaking,less dosage of sufentanil and lower score of agitation,which is suitable for clinical application.

Sarcopenia is a syndrome characterized by progressive and generalised loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life and increasing risk of infection and mortality. Inadequate intake of nutrients (especially protein) might block muscle protein synthesis, and accelerate age-related sarcopenia progress. Age-related decline in skeletal muscle mass as well as muscle functions has been regarded as major health issues in elderly people. The domestic and foreign literature related to impact of nutritional intervention on muscle protein synthesis and muscle functions in elderly people were retrieved to evaluate the effect of nutritional intervention on muscle protein synthesis and muscle functions in elderly people.

Objective To evaluate the dietary risk factors and rational nutritonal intervention for gout and hyperuricemia.Methods PubMed,EMBASE,OVID,Cochrane Library,China National Knowledge Infrastructure (CNKI),and Chinese Wanfang Database were searched for literature related to dietary risk factors and medical nutritonal intervention for gout/hyperuricemia from January 2000 to December 2015.Strict screening of the searched literature was performed based on inclusion and exclusion criteria.The bias risk evaluation tool recommended by the Cochrane Handbook and the Newcastle-Ottawa Scale (NOS) scale were used to assess the quality of included literature.With odds ratios (OR) of gout/hyperuricemia for subjects with different dietary preferences as the main effect indicator,a meta-analysis was conducted,with data collected from literature and summarized by RevMan 5.1 software.Results Nine studies were included eventually.Compared with subjects with lowest intake of red meat,seafood,alcohol,sweented soft drinks or natural juice,the OR for gout/hyperuricemia among subjects with highest intake of these foods was 1.39 (95％ CI:1.18-1.63,P ＜0.0001),1.59 (95％ CI:1.33-1.90,P＜0.00001),3.14 (95％ CI:2.17-4.53,P＜0.00001),1.69 (95％ CI:1.17-2.43,P =0.005),and 1.46 (95％ CI:1.18-1.80,P =0.000 5),respectively.In contrast,compared with subjects with lowest intake of dairy products,vegitables (containing purine-rich vegetables) or coffee,the OR for gout/hyperuricemia among subiects with highest intake of these foods was 0.50 (95％ CI:0.40-0.64,P＜0.00001),1.01 (95％ CI:0.85-1.19,P=0.95),0.48 (95％ CI:0.30-0.78,P =0.003),respectively.Conclusions Patients with gout or hyperuricemia should avoid or restrict the intake of high-purine animal foods (especially red meat and seafood),alcohol,high fructose or corn syrupsweetened foods,while abstinence of purine-rich vegetables is not required.Regular intake of dairy products and coffee is recommended for such patients.

Objective To compare the efficacy of ultrasound -guided bilateral superficial cervical plexus block combined with general anesthesia and single general anesthesia in patients undergoing thyroidectomy.Methods 60 patients with ASAI ~II undergoing thyroidectomy,in accordance with the random number table,were divided into bilateral superficial cervical plexus block combined with general anesthesia group (group A)and single general anesthesia group(group B),30 cases in each group.In group A,the patients were provided ultrasound -guided bilateral superficial cervical plexus block with 0.4% ropivacaine 40 ml(20 mL for each side)before general anesthesia induction.In group B,the patients were directly induced for general anesthesia.The patients of the two groups had the same general anesthesia induction drugs.SBP,DBP and HR were monitored and recorded at the time of pre -anesthesia,skin incision, postoperation and extubation.The cumulative amount of propofol and remifentanil during the operation were recorded. The extubation time was recorded and each patient was assessed 1,2,3,4h after surgery for resting VAS score. Results Blood pressure and heart rate at the different time points during operation were higher than pre -anesthesia significantly in group B[skin incision SBP (134.8 ±8.5)mmHg,the end of operation SBP (123.4 ±5.1)mmHg, tracheal extubation SBP (138.7 ±8.5)mmHg vs preanesthesia SBP (117.3 ±9.8)mmHg,t =7.39,3.02,9.04,all P =0.00;skin incision DBP (86.7 ±7.6)mmHg,the end of operation DBP (80.6 ±7.8)mmHg,tracheal extubation DBP (87.4 ±5.8)mmHg vs preanesthesia DBP (75.6 ±6.6)mmHg,t =6.04,2.68,7.35,all P =0.00;skin incision HR (92.4 ±6.5)times/min,the end of operation HR (86.8 ±6.3)times/min,tracheal extubation HR (96.9 ± 7.2)times/min vs preanesthesia HR (78.9 ±6.8)times/min,t =7.86,4.67,9.96,all P =0.00].The cumulative amount of general anesthesia during operation in group A was less than that in group B,the extubation time in group A was shorter than that in group B[propofol doses of group A (650.6 ±50.3)mg vs group B (762.3 ±43.5)mg,t =9.2,P =0.00;remifentanil doses of group A (0.61 ±0.08)mg vs group B (0.95 ±0.06)mg,t =18.62,P =0.00;extubation time of group A (10.6 ±5.1)min vs group B (15.5 ±5.2)min,t =3.68,P =0.00].The resting VAS score at the different time points after surgery in group A was less than that in group B[the resting VAS score at 1,2, 3,4h after surgery in group A vs group B,(0.99 ±0.81)vs (1.75 ±1.23),t =2.83,P =0.00;(1.23 ±1.02)vs (3.45 ±0.84),t =9.2,P =0.00;(2.80 ±0.85)vs (3.71 ±1.19),t =3.41,P =0.00;(3.11 ±1.02)vs (5.19 ± 1.36),t =6.7,P =0.00],there were statistically significant differences.Conclusion Ultrasound -guided bilateral superficial cervical plexus block combined with general anesthesia used in patients undergoing thyroidectomy can maintain the intraoperative hemodynamic stability effectively,reduce the amount of general anesthetics,shorten the extubation time,and ease the early postoperative pain,the efficacy is significantly better than single general anesthesia.

Objective To observe the clinical effect of dexamethasone combined with dezocine on the ultrasound guided interscalene brachial plexus block.Methods Accordance with the random number table,80 patients with ASAⅠ ~Ⅱ undergoing upper extremity operations were divided into four groups,with 20 cases in each group:group A was treated with 0.45% ropivacaine mesylate 20mL;group B was treated with 0.45% ropivacaine mesylate combined with dexamethasone 0.1mg/kg 20mL;group C was treated with 0.45% ropivacaine mesylate combined with dezocine 0.1mg/kg 20mL;group D was treated with 0.45% ropivacaine mesylate combined with dexamethasone 0.1mg/kg and dezocine 0.1mg/kg 20mL.The onset time,maximum block time,analgesia duration and the incidence of adverse reactions were recorded in the four groups.Results The onset time of group C and group D were faster than group A and group B[group C(3.65 ±0.88)min vs.group A(5.60 ±0.88)min,group B(5.35 ±0.81)min,t =7.303, 6.367,all P =0.000;group D(3.30 ±0.80)min vs.group A,group B,t =8.614,7.678,all P =0.000],the maximum block time of group C and group D were faster than those of group A and group B[group C(8.45 ±1.19)min vs. group A(12.75 ±2.05)min,group B(12.65 ±1.90)min,t =8.583,8.383,all P =0.000;group D(7.80 ±0.89)min vs.group A,group B,t =9.880,9.680,all P =0.000].The analgesia duration of the other groups were longer than those of group A[group B(430.50 ±30.86)min,group C(435.00 ±38.46)min,group D(534.50 ±46.73)min vs. group A(314.50 ±33.32)min,t =9.696,10.072,18.388,all P =0.000],group D was the best(group D vs.group B,group C,t =8.693,8.317,all P =0.000),there were no significant differences between group B and group C (group C vs.group B,t =0.376,P =0.708).In the 80 patients,only one case of group C had postoperative nausea and vomiting symptoms,there were no significant differences between the groups(all P >0.05).Conclusion Dexa-methasone combined with dezocine on the ultrasound guided interscalene brachial plexus block is a method with faster onset time,shorter maximum block time,longer analgesia duration,and it has less adverse reactions and better anesthetic effect,and it is more suitable for upper extremity operations.