ObjectiveTo explore the PBL mode in training students' ability,improve the quality of teaching effect,in the teaching of Clinical therapeutic ultrasound and the teaching method based on problems with discussion method.MethodsTo 31 subjects of study who were randomly divided into five groups,each 6 people,a PBL teaching mode was used for 12 periods by proposing and study,group discussion,the whole class exchange and commenting on summary.ResultsThe survey shows that 93.6％ students think the teachers' design has gained their ends,71％ students are impressed by the knowlege and 96.8％ of the students show the good learning attitude,64.5％ of the students raised their interest in learning,which shows teaching results are effective.ConclusionPBL mode is superior to LBL teaching mode in training students' ability,improving the quality of teaching effect.

In the context of ongoing health reform,it is important to establish and improve the regulation system of public hospitals.By defining the concept of regulation,regulation theories for public hospitals,the regulation systems of the typical countries,the paper summarizes the international experience enlightenment to China's public hospital regulation reform.

Objective To observe the 2-year survival situation of high intensity focused ultrasound(HIFU) treatment in unr esectable advanced pancreatic carcinoma.Methods Thirty-eight patients with unresectable pancreatic cancer received HIFU treatment.After treatment,the changes of laboratory tumor markers examination results,pain score,life quality score and survival situation were recorded.Results Among 35 patients with pain symptom before HIFU treatment,pain was relieved after HIFU treatment in 28 cases,the remission rate was 80.0％.The CA19-9 and CEA levels after HIFU therapy were obviously reduced compared with before treatment.The imaging examination showed the coagulation necrosis in HIFU-treated area.It was found the tumor volume was obviously shrunk during follow-up period.The median survival period was extended to (12.9 ± 6.6) months.Conclusion The HIFU treatment can effectively improve the life quality in the patients with unresectable pancreatic cancer and extends their survival period.

Objective To investigate the influences of heart in patients with hepatocellular carcinoma closed to heart after high intensity focused ultrasound ablation(HIFU). Methods Thirty four patients with hepatocellular carcinoma closed to heart received detecting the values of periphery blood aspartate transarninase(AST), creatine kinase (CK), CK-MB, α-hydroxybutyrate dehydrogenase (α-HBDH), lactate dehydrogenase(LDH), myoglobin(Myo) and troponin I (cTnI) before and 1,3, 7 days after HIFU respectively. ECG was monitored in all patients simultaneously. Results The values of AST,CK,CK-MB,α-HBDH, LDH and Myo increased 1 day after HIFU significantly (P<0.05), which decreased greatly 3 days after HIFU and nearly recovered well (P>0.05) 7 days after HIFU. However, the value of cTnI and ECG were normal before and after HIFU. Conclusions No obvious myocardium injury was found after HIFU in patients with hepatocellular carcinoma dosed to heart, cTnI may be an important marker to evaluate myocardium injury after HIFU.

Objective To investigate the safety and effect of high intensity focused ultrasound ablation(HIFU) on residual liver cancer in patients after radiotherapy. Methods Twenty liver cancer patients with twenty five residual tumors after three-dimensional conformal radiotherapy or stereotactic radiotherapy received HIFU ablation. Liver function and periphery blood cell counts were performed before HIFU and at 1 week after HIFU in all patients. Enhanced MRI and α-fetoprotein (AFP) level were performed before HIFU and at 2 weeks after HIFU to evaluate the effect of HIFU ablation. The survival of all patients was assessed by the Kaplan-Meier method. Results The mean follow-up time was (12.6 ± 8.0)months. The median survival time and 1-year survival rate were 22 months and 87.5% respectively. No skin burns were observed in all patients. As compared with before HIFU,there were no significant differences in the levels of albumin,alanine transarninase, aspartate transarninase, total bilirubin, direct bilirubin, blood red cell counts,blood white cell counts and blood platelet counts at 1 week after HIFU (paired t test, P =0. 156,0. 356,0. 203,0.659,0. 531,0. 519,0. 310,0. 346, respectively). Significant difference in AFP level of 9 patients with AFP＞20 μg/L was observed before HIFU and 2 weeks after HIFU (paired t test, P =0.030). Among 25 residual liver tumors,sixteen with complete ablation and six with ablation volume of ≥80% were observed by enhanced MRI at 2 weeks after HIFU. Conclusions HIFU may be a safe and effective new method to ablate residual liver cancer after three-dimensional conformal radiotherapy or stereotactic radiotherapy.

Objective To investigate the clinical efficacy and feasibility of 125I seeds implantation combined with high intensity focused ultrasound (HIFU) for portal vein tumor thrombus (PVTF) from HCC.Methods Nineteen cases of PVTT from HCC (17 males,2 females;average age:50 years,stage:Ⅰ-Ⅲ)undergoing 125I seeds implantation combined with HIFU from March 2011 to October 2013 were retrospectively studied.The radioactivity of each 125I seed was 18.5 MBq and the matched peripheral dose was 90-120 Gy.HIFU parameters were set as follows:ultrasound wave frequency,0.85 mHz;output power,300-400 W;total treatment duration,33-70 min.During the follow-up of 3-24 months,the change of PVTT size,postoperative complications and survival rate were recorded.Kaplan-Meier method was used to analyze the survival rate.Results The treatment was successfully completed in all patients and no serious complications were observed.After 1 month of follow-up,the tumor thrombi shrank in all patients.Among 19 patients,9 achieved PR,4 SD,6 PD.The one-year and two-year survival rates were 47.4％ and 7.9％,respectively.The mean survival was 11.6±3.0 months (range:3-24 months).The median postoperative survival for stages Ⅰ,Ⅱ,Ⅲ was 13.5,7.0,4.0 months,respectively.Conclusion 125I seeds implantation combined with HIFU could be a safe and effective therapy for PVTT from HCC.

Objective:To evaluate macular microvessel changes in familial exudative vitreoretinopathy (FEVR) by optical coherence tomography angiography.Methods:Cross-sectional clinical case-control study. From November 2019 to November 2020, 21 FEVR patients (41 eyes) from Weifang Eye Hospital were selected; 17 healthy volunteers (28 eyes) with the same age and gender as FEVR group were selected as normal control group. According to the best corrected visual acuity (BCVA) 1.0 and <1.0, FEVR group was divided into normal visual acuity group (27 eyes) and visual acuity decreased group (14 eyes). All enrollees received BCVA and OCTA. BCVA was performed with an international standard visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) vision. The OCTA instrument was used to scan the macular area of all the examined eyes in the range of 3 mm×3 mm, 6 mm×6 mm, and the blood vessel density (VD) and blood perfusion density (PD) within the range of 3 mm×3 mm, 6 mm×6 mm were measured and the area, circumference, and morphological index of the foveal avascular zone (FAZ) within the range of 6 mm×6 mm. Quantitative data were compared between groups by independent sample t test. Statistical data were compared by χ 2 test. The area under curve (AUC) of each index was determined according to receiver operating characteristic curve (ROC curve), and the predictive value of each index was evaluated. Results:In the macular area of 6 mm×6 mm, VD, PD, FAZ area and FAZ perimeter of FEVR group were all lower than those of normal control group, and the differences were statistically significant ( t=-3.350, -2.387, -3.519, -3.029; P<0.05). In macular area of 3 mm×3 mm and 6 mm×6 mm, compared with normal vision group and vision loss group, both VD and PD decreased. The differences were statistically significant ( t=2.088, 2.114, 2.160, 2.545; P<0.05). In the macular area of 6 mm×6 mm , the FAZ morphological index of the two groups was significantly different ( t=2.409, P<0.05). ROC curve analysis showed that all the indicators had low diagnostic value for FEVR (AUC<0.5). Conclusion:There are microvascular abnormalities in macular area in FEVR patients, and the decrease of blood vessels and the change of FAZ shape may be related to the loss of visual acuity.

Objective To observe the clinical effect of high intensity focused ultrasound (HIFU ) in treating spontaneous hy-poglycemic insulinoma .Methods Ten patients with typical repeated spontaneous hypoglycemic insulinoma without predisposing causes were treated by HIFU .The changes of insulin and blood sugar were observed after treatment .Results HIFU could non-in-vasively and directly ablate insulinoma .The insulin level and fasting blood glucose level recovered to the normal levels at postopera-tive 1 week and significantly improved compared with before operation (P<0 .05) .Conclusion HIFU is a non-invasive ,safe and ef-fective method for treating insulinoma .

Objective:To investigate the clinical efficacy of 3D printed metal augment or tibial prosthesis for reconstruction of large bone defects in total knee arthroplasty (TKA) and knee revision surgery.Methods:A total of 7 patients (7 knees) with TKA or knee revision who were admitted to the Department of Orthopaedics of the Second Affiliated Hospital of Zhejiang University School of Medicine with large bone defects from July 2018 to December 2023 were retrospectively analyzed, including 4 patients with TKA and 3 patients with knee revision. There were 3 males and 4 females, aged 58.7±7.6 years (range, 54-68 years), 3 patients with left knee and 4 patients with right knee. All the patients had bone defects in the knee joint (AORI type III), 2 cases had bone defects only in the femur, 4 cases had bone defects only in the tibia, and 1 case had bone defects in both the tibia and femur, which were treated with personalized reconstruction using 3D printing. Hip-knee-ankle angles, American Knee Society score (KSS) before and after surgery were compared, and postoperative complications were observed.Results:All patients successfully completed the operation, and the operation time was 189.3±35.5 min (range, 125-240 min). Complex TKA was performed in 4 cases with surgical times of 175, 195, 210, and 240 min, and revision surgery was performed in 3 cases with surgical times of 125, 180, and 200 min, respectively. Intraoperative blood loss was 114±24.4 ml (range, 100-150 ml). Five cases used 3D printed metal augment, and two used 3D printed one-piece tibial components. All patients were followed up for 2, 2, 5, 6, 7, 20, 57 months, respectively. The KSS of the five patients at 3 months postoperatively were 56, 61, 66, 56, and 56 points, respectively, greater than the preoperative scores of 35, 44, 36, 27, and 41 points. The KSS functional scores of the five patients at 3 months postoperatively were 45, 45, 45, 30, and 45 points, respectively, which were greater than the preoperative scores of 30, 30, 15, 20, and 20 points. The hip-knee-ankle angle was 181.8°±3.4° (range, 177.9° to 188.0°) at the final follow-up and 175.8°±12.4° (range, 153.3° to 192.1°) before surgery, with no significant difference ( t=-1.230, P=0.242). At the final follow-up, the 3D printed component was well integrated with the bone surface, the prosthesis was securely positioned, and the force lines of the lower limbs were normal. There were no postoperative complications such as poor wound healing, infection, fat liquefaction, nerve injury, deep vein thrombosis of lower limbs, knee joint stiffness, periprosthesis infection and loosening. Conclusion:Using 3D printed metal augment or tibial prosthesis to reconstruct the huge bone defect in TKA and revision has a satisfactory early clinical effect, satisfactory joint function and good surgical safety.

【Objective】 To establish a routine screening method for unexpected antibodies of blood donors, analyze the results of centralized screening for unexpected antibody of blood donors in the blood center, and compare the cost of centralized and decentralized screening modes. 【Methods】 A total of 35 591 blood donors were screened for unexpected antibodies from March 31, 2021 to July 31, 2021, using microcolumn gel method. Unexpected antibody screening reactive samples were further confirmed by the Transfusion Research Institute of Shenzhen Blood Center, and the demographic characteristics were further determined through the analysis of unexpected antibody positive population. The direct cost and indirect cost of centralized and decentralized unexpected antibody screening mode were compared. 【Results】 Forty unexpected antibody positive samples were confirmed in Shenzhen, with the positive rate at 0.11%(40/35 591), among which MNS, Rh and Lewis system accounted for 35% (14/40), 32.5% (13/40) and 17.5% (7/40), respectively. Males and females accounted for 45% (18/40) and 55% (22/40), respectively (P<0.01). No significant difference was noticed by age and repeated-donor or not (P>0.05). Unexpected antibody screening in a centralized way saved about 1.16 million yuan per year. 【Conclusion】 It is necessary to carry out unexpected antibody screening for all blood donors, and centralized screening is more economical than decentralized screening.