Objective To study the methods of differential diagnosis of focal nodular hyperplasia and hepatic adenoma using multiphasic helical CT.Methods The data triphase helical CT of focal nodular hyperplasia (FNH) in 7 cases and hepatic adenomas in 5 cases proved pathologically were aualysed.The number,morphology,size,central scars and calcifications of lesions were observed,and the CT values of lesions and liver parenchyma on plain scan,arterial phase and portal venous phase were measured respectively.Results In 7 cases of FNH , mulitple lesions were present in one case , single lesion was in other 6 cases , totally 10 lesions in which six lesions were larger than 3 cm and four of the other were smaller than 3 cm in diameter , the central scars were detected in 7 cases . Five cases of hepatic adenoma were single and larger than 3 cm in diameter, no central scars were detected . Both focal nodular hyperplasia and hepatic adenoma no calicification could be seen . The study showed no significant difference between mean density values of focal nodular hyperplasia ( 48.18?7.82 ) HU and hepatic adenoma ( 42.54?2.37 ) HU on plain scan . In aterial phase , CT values were significant higher in focal nodular hyperplasia(124.29?18.69) HU than that in hepatic adenoma(83.29?9.09) HU.In the portal venous phase,no significant difference in values were detected between focal nodular hyperplasia(110.51?22.71) HU and hepatic adenoma(123.75?5.01) HU.Conclusion The differential diagnosis of focal nodular hyperplasia and hepatic adenoma can be done by multiphasic helical CT in combination with the quantitative evaluation of the density of liver lesions.

Objective To evaluate the postoperative pain induced by various therapeutic catheters after abdominal surgery.Methods A prospective study was conducted in patients selected based on the inclusion criteria.The general condition of the patients was recorded,and nutritional risk screening was performed.The indwelling of therapeutic catheters after abdominal surgery were recorded,including urinary catheter,nasogastric tube,peritoneal drainage tube,common bile duct drainage tube,wound drainage tube,central venous catheter and peripherally inserted central catheter.The pain caused by each type of catheters was evaluated using visual analog scale at 24,48 and 72 hours after tube/catheter insertion.Results A total of 157 patients were selected,including 70 males and 87 females,aged (60.5 ± 12.5) years,with a body mass index of (23.8 ± 3.2) kg/m2,and a total nutritional risk rate of 42％.According to visual analog scale scores,the degrees of pain due to the therapeutic catheters,in descending order,were as follows:4.9 ± 1.7 for nasogastric tube,3.6 ± 0.9 for wound drainage tube,3.0 ±0.9 for urinary catheter,2.6 ±0.9 for central venous catheter,2.4 ± 1.0 for peritoneal drainage tube,1.9 ± 0.7 for common bile duct drainage tube,and 1.8 ± 0.8 for peripherally inserted central catheter.The catheter-induced pain accounted for (44.9 ± 14.1)％ of the total pain during the hospital stay.Conclusions Nasogastric tube,wound drainage tube and urinary catheter can increase the pain of patients.It is therefore recommended to remove the indwelling tubes as early as possible if only the removal does not harm the outcome of the patient.

Objective: To analyze the clinical pathologic characteristics of cases with fluorescence in situ hybridization (FISH) positive of exfoliated urothelial cells, so as to evaluate the clinical utility of FISH in the diagnosis of urothelial carcinoma (UC).Methods: A total of 271 cases of FISH positive in Department of Urology of Peking University First Hospital from Apr.2012 to Sep.2015 were recruited in this study.Retrospective analysis was made on their clinical data.For FISH analysis, labeled probes specific for chromosomes 3, 7, 17, and the p16 (9p21) gene were used to assess chromosomal abnormalities indicative of malignancy.The positive predict values (PPV) of all the techniques were analyzed.Results: Of the 271 patients, 207 cases were UC, 7 cases were non-UC, and 57 cases were benign diseases.The PPV of FISH in detecting UC was 76.4%, while the 95% confidence interval (CI) 71.3% to 81.5%.In the cohort of FISH positive, this value was similar to that of urinary cytology (PPV 86.8%, 95% CI: 78.5%-95.0%).The PPV of FISH was lower than that of cystoscopy and ureteroscopy (PPV 96.1%, 95% CI: 91.7%-100.0%).There were significant differences between this study and the PPV of FISH reported abroad (PPV 53.9%, χ2=33.048, P<0.001).Of all the UC with FISH positive, bladder cancer showed an earlier pathological stage versus renal pelvic carcinoma and ureteral carcinoma, with significance (χ2=5.894, P=0.015, and χ2=13.601, P<0.001, respectively).However, no difference was found in the size, pathological stage and pathological grade of tumors between the urinary cytology positive group and the urinary cytology negative group.The rate of high-grade UC in ureteral carcinoma of FISH positive was 92.3%, much higher than that of ureteral carcinoma reported domestically.Conclusion: The PPV of FISH in detecting UC is higher relatively, with a better clinic value for Chinese patients.The ureteral carcinoma with FISH positive obtains a higher pathological grade, which is of great guiding significance for UC.

Objective To investigate the risk factors associated with cerebrospinal fluid (CSF) fistulas due to endoscopic transnasal surgery for pituitary neoplasms.Methods The data of 1,063patients were reviewed who had undergone transnasal surgery for pituitary adenomas between January 2009 and December 2012 at Department of Neurosurgery,General Hospital of PLA in Beijing.Intra-operative CSF fistulas were observed in 122 patients but not in the other 941 ones;post-operative CSF fistulas were observed in 29 patients but not in the other 1,034 ones.The clinical data were compared between the patients with and without intra-operative CSF fistulas and between those with and without post-operative CSF fistulas.Chi-square was used to identify the potential risk factors associated with intra-and post-operative CSF fistulas.Multivariate Logistic analysis was performed for correlated variables.Results There was a significant difference in tumor size between the patients with and without intra-operative CSF fistulas (P＜0.05).There were significantly more patients undergoing reoperation in those with intra-operative CSF fistulas than in those without (P＜0.05).The multivariate Logistic analysis revealed that giant adenoma,macroadenoma and reoperation were independently associated with intraoperative CSF fistulas.There was a significant difference in age and tumor size between the patients with and without post-operative CSF fistulas (P＜0.05).There were significantly more patients undergoing reoperation and suffering intraoperative CSF fistulas in those with post-operative CSF fistulas than in those without (P＜0.05).The multivariate Logistic analysis revealed that giant pituitary neoplasms,reoperation and intra-operative CSF fistulas were independently associated with post-operative CSF fistulas.Conclusions In endoscopic transnasal surgery for pituitary neoplasms,the risk factors for intra-operative CSF fistulas are larger tumor size and reoperation and the risk factors for post-operative CSF fistulas are giant pituitary neoplasms,intra-operative CSF fistulas and reoperation.

Objective:To investigate the status of the vestibular function of the patients with chronic positional symptoms after peripheral acute vestibular syndrome (AVS) and the curative effect of the vestibular rehabilitation therapy (VRT). Method:Using caloric test (CT), head shaking nystagmus test (HST), cervical vestibular evoked myogenic potentials as well as ocular vestibular evoked myogenic potentials to estimate the function of semicircular canal and otolith organs. The patients with normal VEMPs are divided as Group A. Otherwise are as Group B. Both groups are treated with VRT. The curative effect is estimated by vestibular symptom index (VSI) and Berg balance scale (BBS). Result:Thirty-three of 37 patients (86.5%) had an abnormal result of CT and HST, with 23 of these patients (65.7%) had an abnormal of both test. Twenty-two patients (59.5%) were in Group A and 15 (40.5%) in Group B. Before the therapy, Group B had a higher score of the balance and dizziness symptoms of VSI (P<0.05), and Group A had a higher score of the BBS (P<0.05). After the therapy, the VSI scores of both groups dropped and scores of the BBS raised. Conclusion:Patients with chronic positional symptoms after peripheral AVS have dynamic vestibular lesions to different extents. Those with otolith organs lesions tend to have a worse function of balance. Nevertheless, patients have a better off after VRT.

ObjectiveTo investigate the association between ZJU index and the onset of nonalcoholic fatty liver disease （NAFLD） in the Uygur population and the value of ZJU index in predicting the risk of NAFLD. MethodsThe Uighur community of The 51st Regiment of The Third Division of Xinjiang Kashgar Corps was selected as the investigation site， and the Uygur residents who lived in this area and had an age of >18 years were selected as subjects. Follow-up studies were conducted in 2019， 2020， and 2021， and the investigation of outcomes was completed in June to August of 2021. Finally 10 597 subjects were enrolled for analysis. The Kruskal-Wallis H test was used for comparison of continuous variables between groups， and the chi-square test was used for comparison of categorical variables between groups. The subjects were divided into Q1-Q4 groups according to the level of ZJU index. The Kaplan-Meier curve was used to predict the incidence rate of NAFLD， and the Cox regression model was used to analyze the association between ZJU index and the risk of NAFLD； the area under the ROC curve （AUC） was used to evaluate the value of ZJU index in predicting the risk of NAFLD. ResultsDuring the median follow-up time of 4.92 years， the incidence rate of NAFLD was 9.4% （992/10 597） among the study population. After adjustment for multiple factors， there was a significant increase in the risk of NAFLD with the increase in ZJU index， with a hazard ratio of 2.55 （95% confidence interval ［CI］： 1.60‍ — ‍4.06）， 7.32 （95%CI： 4.78‍ — ‍11.20）， and 21.74 （95%CI： 14.32‍ — ‍33.00）， respectively （all P_trend<0.001）. The ROC curve showed that ZJU index had a higher value in predicting NAFLD （AUC=0.816）， and the male subgroup had a significantly higher predictive accuracy of ZJU index than the female subgroup （AUC： 0.829 vs 0.809）. ConclusionZJU index is a predictive factor for the onset of NAFLD in the Uygur population in rural areas of Xinjiang and has a good value in predicting the risk of NAFLD.