Currently, medical ultrasound teaching focuses on the delivering the image infor-mation itself, while its connection with basic medicine and clinical medicine is neglected. Such a teaching method is not good for students to establish a systemic view. To conduct the ultrasound medi-cine education effectively in undergraduate students, we have tried some reforms, including: perform-ing diseases or problem based teaching, integrating basic medicine, ultrasound medicine and clinical medicine throughout the whole teaching process, providing as many practice opportunities as possible for the graduates and integrating the ultrasound imaging with other medical imaging modalities. The practice shows that with the reform, the students have a better understanding of ultrasonic knowledge itself, a better grasp of the whole medical knowledge structure, and also have a preliminary impression on how to diagnose the disease through reasonable application of different treatments. In addition, students have more passion for study.

Objective To observe characteristic imaging of traumatic arteriovenous fistulas(TAVF) and to evaluate the methods of differential diagnosis of TAVF by Doppler ultrasonography. Methods Eleven patients suffering from TAVF were selected to have the examination of Doppler ultrasonography. The blood flow of arteriovenous fistulas, diameter, morphology and blood flow character of affected vessels were observed. Spectral of fistula and affected vessels were analyzed and compared with the healthy side. Results Localization of arteriovenous fistulas was observed directly in eight patients, which presented as intercepted wall of the affected vessels and irregular mosaic flashes flowing towards enlarged vein from artery. Pulsed wave Doppler showed unilateral continuant spectral with maximum velocity 300-390 cm/s when sampled in the fistula. Spectral analysis of proximal arteries of the fistula revealed high velocity and low resistance. Arterialized flow pattern was observed in affected veins. Proximal veins of the fistula revealed arterialized spectral with high velocity and low resistance. Reversed centrifugal blood flow was observed in the distal veins of the fistulas in 4 cases. Conclusions Unilateral shunt in both diastole and systole in the fistula and arterialized flow with high velocity in veins are characteristic presentation of TAVF. Color Doppler ultrasonography has great value in confirming diagnosis and differential diagnosis of TAVF.

ObjectiveTo observe and quantify the effec ts of respiration on hemodynamics in patients with pericardial effusion (PE) and to verify our new proposed hypothesis about the mechanism of respiratory effects on cardiac function from clinical point of view. MethodsPulsed-wave Doppler spectra of the four cardiac valves were recorded with Acuson Sequoia 512 and 128 XP/10 in 10 patients with PE and 18 healthy control subjects with no apparent cardiac and pulmonary abnormalities. Electrocardiogram and respiratory tracing by a nasal thermistor were recorded simultaneously with the echocardiograms. The blood flow velocities of each valve during inspiration and expiration were averaged separately and those were again averaged for 5 consecutive respiratory cycles, and the respiratory variation indices (RVI) were calculated both in the patients and the control groups. ResultsThe peak E velocity across the mitral valve and that across the aortic valve significantly increased during expiration and decreased during inspiration, while that across the tricuspid valve and that across the pulmonary valve increased remarkably during inspiration and decreased during expiration in all of the subjects. The RVI of the velocities across the mitral and the aortic valves increased significantly in the patients with PE compared with the control subjects [MV: ( 14.57 ? 7.89 )% vs ( 9.71 ? 3.39 )%, P

0.05). Conclusions Ultrasound contrast agent Levovist improves signal of blood flow obviously. It increases the diagnostic accuracy for intracranial aneurysms and the level of confidence.

Objective To evaluate the clinical effect and safety of umbilical cord ligation in the fetocide of complicated monochorionic multiple gestations.Methods From January 2009 to December 2012,clinical data of 18 women with complicated monochorionic multiple gestations who experienced intrauterine percutaneous umbilical cord ligation in Peking University Third Hospital were collected.Among the patients,6 were selective intrauterine growth restriction (1 with type Ⅰ,4 with type Ⅱ,1 with type Ⅲ) ; 4 were acrania or hydropic twins; 4 were aeardiac twins,2 were complicated triplet gestation; 1 was twin-twin transfusion syndrome with right ventricular dysplasia and 1 was monochorionic diamniotic (MCDA) with caesarean section history.The procedure was performed under both endoscopic and sonographic guidance.The gestational age at the time of the procedure were 17-27 +6 weeks.The procedure and perinatal outcome were analyzed.Results (1) The procedure was performed successfully in all the 18 cases.The average duration of the procedure was 63 min (24-156 min).The blood loss was 7.6 ml (5-20 ml).The mean gestational age at the time of the procedure was 20 weeks (17-27 +6 weeks).The average birth weight of the neonates was 2441 g(1000-3400 g).(2) There were 20 fetuses survived.Two fetuses had cardiac anomalies and were terminated in the following 2-3 weeks.Intrauterus fetal demise occured in 3 twin reverse arterial perfusion syndrome (TRAP) cases 3-14 weeks after the procedure.1 case delivered as early preterm birth at 28 weeks and the neonate died of respiratory distress syndrome (RDS) and hypoxie-ischemicencephalopathy (HIE).Fourteen neonates were in healthy and normal development by 3-51 months' followup.(3) Fourteen cases delivered at more than 28 weeks (28-38 weeks,averagely 33 + 1 weeks).The gestational weeks were prolonged by 5-21 weeks (averagely 13 +4 weeks).Among them,3 case were early preterm birth (28-33 weeks) and 3 were late preterm birth (34-36 weeks).Conclusion Percutaneous umbilical cord ligation is a reliable technique for the fetocide of complicated monochrionic mutilple gestations,especially for monochronic monoamniotie pregnancies.

Objective To explore the feasibility and safety of single-port laparoscopic surgery in the treatment of incarcerated inguinal hernia in children. Methods The clinical efficacy of single-port laparoscopic and epidural anesthesia needle treatment for incarcerated inguinal hernia in children of 32 cases were analyzed retrospectively. Results Thirty-two children were operated successfully. The operation time was (16.24 ± 4.67) min for unilateral hernia (in 25 cases) and (21.69 ± 5.85) min for bilateral hernia (in 7 cases). The blood loss was (2.50 ± 0.56) ml. The recovery time of intestinal peristalsis was (16.42 ± 4.86) h after surgery, and the postoperative hospital stay was (3.25 ± 0.82) d. Intraoperative exploration found 7 cases had concealed contralateral hernia;incarcerated hernia contents included bowel in 27 cases, ovaries in 3 cases, and greater omentum in 2 cases. All the incarcerations were successfully restored by hand and no-damage clamp assistance. The incarcerated organ had good blood flow in all the 32 cases. The follow-up time was (15.62 ± 5.34) months, and there was no recurrence and atrophy of testis or ovaries. Conclusions The single-port laparoscopic surgery for incarcerated inguinal hernia in children has advantages of preservation of anatomy of the inguinal canal easily to perform high ligation of hernial sac, and reduction under direct visual control. Meanwhile, occult inguinal hernia in the opposite side can be cured. It was a safe, effective, and minimally invasive procedure, being worthy of further clinical application.

Objective To assess and delineate the dosimetric shortcomings of conventional radiotherapy planning,as compared with the three dimensional treatment planning system, and to obtain a better technique in the treatment of lung cancers.Methods Thirteen patients with stage ⅢA ⅢB non small cell lung cancer were chosen in the present study. Using the Cadplan 6.0.8 treatment planning system , three different methods of radiotherapy planning: conventional planning, conventional and conformal planning, and conformal planning were designed for each patient. The total radiation dose was 66 ?Gy and DVHs were used to assess the dosimetric distribution in the gross tumor volume and the surrounding organs at risk. Results No significant dosimetric disparity in the target volume was found among the three designs, according to anticipated therapeatic requirements. The conformity indices were 0.13,0.24 and 0.35 for these three radiotherapy designs. The mean lung volumes which received radiation dose of≥20?Gy were 32%,26% and 25%.The mean maximum dose at the spinal cord were 42?Gy,49?Gy and 33?Gy.The mean esophageal volume which received radiation of ≥50?Gy were 32%,34% and 22%, and the mean radiation dose to the heart were 18?Gy,15?Gy and 12?Gy,respectively. Conclusions Conventional radiotherapy planning is able to meet the demands of dosimetric requirements for radiation treatment of lung cancers. The three dimensional conformal radiation therapy planning system is able to provide superior delivery of high dose to the target volume without inflicting too high a risk to the surrounding normal tissues and organs.

Objective On basis of physical dose optimization, LQ model was used to investigate the difference between the curves of biological effective dose and physical isodose. The influence of applying the biological dose concept on three dimensional conformal radiotherapy of prostate carcinoma was discussed. Methods Four treatment plannings were designed for physical dose optimization: three fields, four-box fields, five fields and six fields. Target dose uniformity and protection of the critical tissue -rectum were used as the principal standard for designing the treatment planning. Biological effective dose (BED) was calculated by LQ model. The difference between the BED curve drawn in the central layer and the physical isodose curve was studied. The difference between the adjusted physical dose (APD) and the physical dose was also studied. Results Five field planning was the best in target dose uniformity and protection of the critical tissue -rectum. The physical dose was uniform in the target, but the biological effective doses revealed great discrepancy in the biological model. Adjusted physical dose distribution also displayed larger discrepancy than the physical dose unadjusted. Conclusions Intensified Modulated Radiotherapy (IMRT) technique with inversion planning using biological dose concept may be much more advantageous to reach a high tumor control probability and low normal tissue complication probability.

Objective To compare the long-term efficacies of anterior cervical decompression and fusion (ACDF)and conservative therapy in treatment of unisegmental cervical disc herniation and to analyze the degree of the long-term adjacent segment disc degeneration in ACDF.Methods 120 patients treated in our hospital from January 2006 to January 2009 were selected,60 patients underwent ACDF as operation group and 60 patients underwent physical therapy and drug (conservative therapy)as non-operation group. All the patients were recorded when they were diagnosed with cervical unisegmental cervical disc herniation, and followed-up for 60 months, and they were evaluated with American Spinal Injury Association (ASIA)score,Visual Analogue Scale (VAS),Japanese Orthopedics Association (JOA) score and imaging (Miyazaki grading system). Results 107 patients were followed up,55 patients treated by operation were followed up for an average 59.7 months (59.7±0.4),while 52 patients treated by conservative therapy were followed up for an average 58.8 months (58.8±1.5).Compared with before treatment, the ASIA, JOA, and VAS scores of the patients in two group after treatment were improved (P<0.05),and the scores of ASIA,VAS,and JOA in operation group were superior to that in non-operation group (P<0.05),and adjacent segment disc degeneration occurred more frequently in the upper adjacent segment than the lower adjacent segment (P<0.05).Conclusion ACDF is superior to conservative therapy in alleviating symptoms and improving prognosis of unisegmental cervical disc herniation. Long-term postoperative disc degeneration mainly occurrs in the upper segment.

Objective To study the expression of GRHL-3 in diffuse large B-cell lymphoma (DLBCL) tissues and its clinical significance.Methods One hundred and sixty-eight pathology paraffin-embedded diffuse large B-cell lymphomas tissues were collected from January 2006 to September 2011.Immunohistochemistry was used to detect the expression of GRHL-3 protein in the above tissues.Results The positive expression rate of GRHL-3 protein in the GCB type tissues was higher than that in the non-GCB type tissues [84.87 ％(101/119) vs 14.29 ％ (7/49), P ＜ 0.01].Further analysis indicated that in the non-GCB type tissues,the positive expression rate of GRHL-3 in the latter stage group was significantly higher than that in the early stage group [90.00 ％ (63/70) vs 77.56 ％ (38/49), P ＜ 0.01].The positive expression rate of GRHL-3 in the lactatede hydrogenase increased group was significantly higher than that in the normal lactated hydrogenase [91.67 ％ (77/84) vs 68.57 ％ (24/35), P ＜ 0.01].The positive expression rate of GRHL-3 in the extranodal involvement status ≥ 2 group was significantly higher than that in the extranodal involvement status 0-1 group [96.29 ％ (26/27) vs 81.52 ％ (75/92), P ＜ 0.05].The positive expression rate of GRHL-3 in the IPI score 4-5 group was significantly higher than that in the IPI score 0-1 group [91.30 ％ (65/69) vs 66.67 ％ (18/27), P ＜ 0.01] and IPI score 2-3 group [91.30 ％ (65/69) vs 79.96 ％ (18/23), P ＜ 0.05].However, the expression of GRHL-3 had no correlation with the gender, age, and performance status of DLBCL.Conclusion The positive expression rate of GRHL-3 protein in the GCB type tissues is higher than that in the non-GCB type tissues.The positive expression rate of GRHL-3 in the DLBCL is correlated with the Ann Arbor stage, lactate dehydrogenase, extranodal involvement status and IPI score.