Objective To use the real-time shear wave elastography(SWE)to detect the elasticmodulus values of different breast lesions,and to assess its application value in differential diagnosis of benign and malignant breast lesions.Methods SWE was per-formed in 71 breast lesions from 63 pathologically confirmed patients.The maximum,minimum and mean elasticmodulus values in breast lesions were detected and the ROC curves were used to determine the optimal diagnostic cut off value.Results Among 7 1 le-sions,48 cases were benign lesions and 23 cases were malignant lesions.The diagnostic accuracy and Youden index of the ordinary ultrasound were 77.5% and 0.55 respectively.The maximum,minimum and mean elasticity values for malignant lesions were (106.7±37.9),(23.7±6.4),(44.8±6.6)kPa respectively,whereas which for benign lesions were(42.7±14.6),(17.2±6.3), (29.4±8.0)kPa respectively.The maximum,minimum and mean elastic values had statistically significant differences between be-nign and malignant lesions(P<0.05).The areas under the curve(AUC)of the maximum,minimum and mean elastic values were 0.963,0.798 and 0.914 respectively.Taking 78.1 kPa as the threshold of the maximum elasticity value,the sensitivity was 82.6%and the specificity was 95.8%.Taking 37.6 kPa as the threshold of the mean elasticity value,the sensitivity was 87.0% and the specificity was 83.3%.Conclusion SWE provides a new way for the differential diagnosis of benign and malignant breast lesions, and the maximum and mean elastic value can be used as the diagnostic evidence for differentiating benign and malignant breast le-sions.

Objective: To compare the contents of saikosaponin a, d and total flavonoids in different parts of Hollow bupleurum to provide reference for the clinical use of medicinal parts.Methods: The determination was performed on a SHIMADZU Inertsil C18(250 mm×4.6 mm,5 μm)column.The mobile phase consisted of acetonitrile and water with the ratio of 40∶60, and the flow rate was 1.0 ml·min-1.The detection wavelength was 210nm, the column temperature was 40℃, and the injection volume was 10 μl.A colorimetric method was used to detect total flavonoids with the detection wavelength of 500 nm.Results: The calibration curve of Saikosaponin a, d and total flavonoids showed a good linear relationship respectively over the range of 0.21-1.26 mg·ml-1(r=0.999 6),0.25-1.51 mg·ml-1(r=0.9997) and 4.00-25.00 μg·ml-1(r=0.999 6).The average recovery was 99.27%(RSD=2.15%, n=6),99.4%(RSD=2.14%,n=6)and 99.03%(RSD=1.34%,n=6), respectively.The content of saikosaponin a and d respectively was 0.31% and 0.50% in the root, while that in the other parts was low.The content of total flavonoids was as high as 8.48% in flowers, and that in leaves, stem and root reduced in turn.Conclusion: The aerial parts of Hollow bupleurum are rich in flavonoids, and the content of saikosaponin in root is higher, therefore, the whole plant with root is more reasonable in the clinical use.

Objective To explore the clinical outcomes of treating unstable intertrochanteric fractures with proximal femoral locking plate (PFLP) in the elderly patients.Methods From January 2010 to June 2015,380 elderly patients with unstable intertrochanteric fracture were treated with PFLP and successfully followed up at our department.They were 171 men and 209 women,from 60 to 89 years of age (average,68.7 years).By AO classification,there were 58 cases of AO31-A2.2,87 ones of 31-A2.3,130 ones of 31-A3.1,63 ones of 31-A3.2,and 42 ones of 31-A3.3.Operation time,incision length,length of hospital stay,fracture healing time,postoperative complications and hip joint Harris scores were recorded.Results This cohort was followed up for an average of 13.3 months (range,from 8 to 21 months).Their operation time averaged 53.2 min,X-ray exposure 12.2 times,intraoperative blood loss 92.7 mL,incision length 12.6 cm,postoperative drainage volume 54.7 mL,and length of hospital stay 9.2 days.Pulmonary infection was observed in 3 cases,fixation loosening in 8,fixation breakage in 2,hip varus in 9,and fracture nonunion in 4,yielding a total complication rate of 6.8％ (26/380).No operative incision infection was observed.The average fracture healing time was 11.8 weeks (range,from 7 to 48 weeks) after operation.The average Harris score one year postoperation for the 380 patients was 86.3 ± 6.1,significantly higher than the preoperative value (43.6±4.4) (P ＜0.05).There were 96 excellent,231 good,42 fair and 11 poor cases,giving an excellent to good rate of 86.1％.Conclusion Since PFLP has advantages of limited invasion,blood loss and complications,a high rate of fracture healing,and good functional recovery of the hip,it may be a good treatment for unstable intertrochanteric fractures in the elderly patients.

Objective To explore the efficacy of proximal femur locking plate(PFLP) for the treatment of unstable femoral intertrochanteric fractures in elderly patients.Methods Data of 120 cases of patients with unstable femoral intertrochanteric fractures who were treated by PFLP were retrospectively analyzed.There were 56 males and 64 were females,aging from 62 to 78 year-old (average,69.4 year-old).85 cases were left hip,and 35 cases right hip.According to AO fracture classification,there were 12 cases of A2.2,23 A2.3,34 A3.1,29 A3.2,and 22 A3.3.According to Evans intertrochanteric fractures classification:there were 93 cases of type Ⅲ,19 type Ⅳ,and 8 type Ⅴ.Operation time,length of hospital stay,fracture healing time,postoperative complications and hip joint Harris scores were recorded.Results All patients were followed up for 8-14 months (average,12.4 months).Their operating time were 51-80 min (average,63.1 min);X-ray exposure were 8-15 times (average,11.6 times);intraoperative blood loss were 70-120 ml (average,92.7 ml);postoperative drainage volume were 50-100 ml (average,61.7 ml),and length of hospital stay were 7-14 d (average,10.2 days).The healing time ranged from 12 to 32 weeks (20.4 weeks average).14 cases had delayed union,and healing time was 8-10 months.In addition,4 cases had deep vein thrombosis (after thrombolysis therapy the vein was recanalized);2 had internal fixation broken,who were then treated with PFNA Ⅱ,and bone healed after 6 months;5 had hip varus,who were then treated via hip replacement,and no hip prosthesis fracture were found.No other complications occurred in the remaining patients.At the latest follow-up,according to Harris hip score:there were 38 cases with excellent results,71 good,9 fair,and 2 poor,and the rate of excellent and good was 90.8％ (109/120).Conclusion PFLP for the treatment of unstable femoral intertrochanteric fractures has advantages of less invasion,less complication,reliable fixation and high fracture healing rate,thus it is suitable for unstable intertrochanteric fractures in elderly patients.

Objective To detect and analyse the levels of nitrite in marketed milk powder.Methods 6 brands of maketed milk powder were selected in this study.Interferents,such as protein,were removed from milk powder preliminarily by using potassium ferrocynide and zinc acetate.The levels of nitrite were detected by using fluorospectrophotometry method,and compared with na-tional standard(2 mg/kg).Results The levels of nitrite in the 6 brands of maketed milk powder were lower than the national stand-ard limit,had statistically significant differences(P <0.05).Conclusion The levels of nitrite of 6 brands of milk powders do not ex-ceed the national standard.

Objective To investigate the safety,effectiveness and prognosis of percutaneous microwave ablation (MWA) combined with synchronous transarterial chemoembolization (TACE) to treat of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) with liver metastases (LMs).Methods This retrospective study included 19 cases of GEP-NENs with LMs patients who received percutaneous MWA combined with synchronous TACE treatment from 2013 to 2016.The mRECIST standard was selected to assess the curative effect.SPSS 21.0 software was applied in the statistical analysis of overall survival (OS),progression-free survival (PFS) and factors related to prognosis.Results All patients were capable of curative effect evaluation,including 1 case of complete remission (CR),3 cases of partial remission (PR),7 cases of progressive disease (PD) and 8 cases of stable disease (SD) respectively accounting for 5 ％,16 ％,37 ％,42 ％,which exhibited 21％ of response rate (RR) and 63％ disease control rate (DCR).In the present study,the median OS and median PFS was respectively 25 months and 34 months,and the one-year survival and three-year survival was respectively 95％ and 84％.Serum CA199,the WHO classification of LMs and the tumor burden of LMs were the major risk factors of prognosis through single factor analysis of survival,which showed that G3 of the WHO classification of LMs predicted a poor OS (P＜0.05) and tumor burden of LMs was negatively related to PFS (P＜0.05).It was obviously observed that serum CgA was decreased by the therapy of percutaneous MWA with synchronous TACEfor GEP-NENs (P＜0.05).Conclusions Percutaneous MWA combined with synchronous TACE is a safe and effective method to treat GEP-NENs with LMs.

Objective To investigate the advantage and application prospect of 3D printing technology in assisting surgery for complex tibial plateau fractures.Methods The complete clinical data of 41 patients (48 knees) were retrospectively analyzed.And these patients were divided into two groups as 3D printing assisted operation group and traditional operation group,according to whether 3D printing technology was applied.Study was carried out to compare the clinical efficacy of surgery assisted by 3D printing technology and traditional surgery in the treatment of complex tibial plateau fractures.The 3D printing assisted operation group included 18 patients (22 knees,12 males and 6 females),aging from 16 to 68 (mean age 45.5±7.2),and there were 12 cases of Schatzker Ⅴ and 10 Ⅵ.The traditional operation group included 23 patients (26 knees,15 males and 8 females),aging from 19 to 69 (mean age,46.2±6.8),and there were 14 cases of Schatzker Ⅴ and 12 Ⅵ.The operation time,intraoperative blood loss,the Rasmussen score and hospital for special surgery knee score (HSS) at 6 weeks post-operation were analyzed and the difference between the two groups was tested.Results All those patients were followed up for 7 to 20 months (mean 15 months).For 3D printing assisted operation group,the mean operation time was 81.4±6.3 min for Schatzker Ⅴ and 90.6± 15.4 min for Schatzker Ⅵ;the mean intraoperative blood loss was 200.4±72.3 ml for Schatzker Ⅴ and 280.6±101.6 ml for Schatzker Ⅵ;the result of 6-week Rasmussen score was 14 excellent,6 good and 2 fair (excellent and good rate 90.9％);the result of 6-week HSS score was 15 excellent,5 good and 2 fair (excellent and good rate 90.9％).Then for traditional operation group,the mean operation time was 100.4± 15.3 min for Schatzker Ⅴ and 111.5±20.2 min for Schatzker Ⅵ;the mean intraoperative blood loss was 450.4±173.3 ml for Schatzker Ⅴ and 500.5±247.2 ml for Schatzker Ⅵ;the result of 6-week Rasmussen score was 14 excellent,8 good,2 fair and 2 bad (excellent and good rate 84.6％);the result of 6-week HSS score was 13 excellent,8 good,2 fair and 3 bad (excellent and good rate 80.8％).The difference in operation time,intraoperative blood loss had statistical significance between the two groups;but the difference in 6-month post-operation Rasmussen score and HSS score had no statistical significance.Conclusion Compared with traditional surgery,3D printing technology assisted surgery for complex tibial plateau fracture possesses advantage such as shortened operation time,reduced intraoperative blood loss;but there's no evidence for improved knee function at 6 weeks post-operation.

Objective To analyze the related factors of femoral head necrosis after internal fixation operation of femoral neck fracture.Methods Clinical data of 524 patients with femoral neck fracture who underwent internal fixation surgery between January 2012 and January 2015 were retrospectively analyzed.Taking the femoral head necrosis as an observable indicator,the clinical data of postoperative femoral head necrosis and those other patients who were treated at the same period were compared.Whether the clinical factors (gender,age,surgical reduction type,fracture type,quality of reduction,post-injury operation time,loading time after operation,and whether to withdraw internal fixation) were in correlation with postoperative femoral head necrosis was analyzed by univariate analysis.Then the statistically significant indicators were integrated into logistic regression analysis to determine the related factors of femoral head necrosis.Results According to inclusion and exclusion criteria,the study group consisted of 212 cases,including 94 males and 118 females;the follow-up time was 2-5 years,and the average follow-up time was 3.6±1.6 years.There were 46 cases with femoral head necrosis and 166 cases without femoral head necrosis after operation.The rate of femoral head necrosis was 21.7％ (46/212).The femoral head necrosis group included 46 cases with 21 males and 25 females;20 cases below 60 years old and 26 cases above 60 years old;17 cases using open reduction and 29 cases using closed reduction;6 cases belong to type Ⅰ/Ⅱ and 40 cases belong to type Ⅲ/Ⅳ according to Garden classification;16 cases got satisfactory reduction while 30 cases with unsatisfactory reduction;30 cases below 48 h and 16 cases above 48 h on post-injury operation time;17 cases below 3 months and 29 cases above 3 months on post-operation loading time;22 cases with internal fixation removal and 24 cases without internal fixation removal.The femoral head without necrosis group included 166 cases with 73 males and 93 females;84 cases below 60 years old and 82 cases above 60 years old;69 cases using open reduction and 98 cases using closed reduction;120 cases belong to type Ⅰ/Ⅱ and 46 cases belong to type Ⅲ/Ⅳ according to Garden classification;160 cases got satisfactory reduction while 6 cases with unsatisfactory reduction;119 cases below 48 h and 47 cases above 48 h on post-injury operation time;70 cases below 3 months and 96 cases above 3 months on post-operation loading time;74 cases with internal fixation removal and 92 cases without internal fixation removal.Univariate x2 analysis suggested that fracture type and quality of reduction were associated with postoperative femoral head necrosis.Other clinical factors (gender,age,surgical reduction type,post-injury operation time,loading time after operation and whether to remove internal fixation or not) were not associated with postoperative femoral head necrosis.The multivariate Logistic regression analysis showed fracture type and quality of reduction were significantly related to postoperative femoral head necrosis.Conclusion Femoral head necrosis after internal fixation operation of femoral neck fracture is affected by many factors.The fracture type and quality of reduction are important factors affecting femoral head necrosis after internal fixation operation of femoral neck fracture.

In the era of information technology, the construction of a harmonious doctor-patient relationship is inseparable from the support of information technology. The use of blockchain technology in the medical and health field plays an important role in promoting the construction of a harmonious doctorpatient relationship in the new era. Discuss the organic integration of blockchain technology and the construction of a harmonious doctor-patient relationship in the new era at the three levels of technology, method, and path, and find that the blockchain can provide both technical support and method support for the construction of a harmonious doctor-patient relationship in the new era; Blockchain technology is conducive to promoting the construction of a harmonious doctor-patient relationship in the new era by developing distributed personal lifelong medical accounts, establishing a shared and interactive medical resource service community, and designing a tracking management model for the medical service process.

Objective:To observe any effect of aerobic exercise on lipid deposition in the liver and monoacylglycerol O-acyltransferase 1 (MGAT1) signaling in non-alcoholic fatty liver disease (NAFLD).Methods:Male Sprague-Dawley rats were fed a 45% diet fat for 6 weeks, after which they were confirmed to have NAFLD. The rats were then randomly divided into an exercise group, a sedentary group and a diet adjustment group. The exercise and sedentary groups remained on the high-fat diet, but the exercise group underwent 8 weeks of aerobic exercise, while the diet adjustment group returned to a normal diet without any exercise. After the intervention, lipid accumulation in liver tissues was detected by hematoxylin-eosin staining and hepatic steatosis indices were calculated. Liver MGAT1 and the expression of peroxisome proliferator activated receptor γ (PPARγ) protein were detected using western blotting.Results:Liver steatosis indices in the exercise and the diet adjustment groups had decreased significantly after the eight weeks. The expression of MGAT1 protein had decreased significantly in the exercise group and the expression of PPARγ protein had increased significantly. Compared with the sedentary group, no significant changes were observed in the expression of MGAT1 protein in the livers of the diet adjustment group, though their average PPARγ protein expression had increased significantly. Compared with the diet adjustment group, the average liver steatosis index had increased significantly in the exercise group, but the expression of MGAT1 protein had decreased significantly.Conclusions:Aerobic exercise can significantly improve liver lipid deposition in NAFLD, at least in rats. The mechanism may be related to inhibition of the MGAT1 signal pathway. Aerobic exercise may be a rehabilitation intervention for NAFLD patients.