Objective To evaluate the ability of contrast-enhanced ultrasonography (CEUS ) compared to enhanced MRI scan in differential diagnosis of benign and malign tumor of orbit.Methods CEUS and enhanced MRI was performed in 74 patients with tumor of orbit.These patients were divided into two groups:benign and malignant tumor depended on histological diagnosis.The results were analysed with SonoLiver software.The coincidence rate of diagnosis and enhancement intensity among CEUS,MRI and CEUS+ MRI were compared and the quantitative parameters of CEUS were analysed.Results (1 )The diagnostic accordance rate of benign group by three methods were 90.0%,80.0% and 96.0% respectively, there was statistical difference for diagnostic coincidence rate between the MRI and CEUS+ MRI(P <0.05).The diagnostic accordance rate of malignant group by the above three methods were 75.0%,79.2%and 95.8% respectively,there was no statistical difference for diagnostic coincidence rate between the three methods(all P > 0.05 ).(2 )The enhancement intensity of CEUS was different between benign and malignant groups (P <0.05).There was no statistical difference between benign and malignant groups by MRI method (P >0.05).(3)The parameters of tumor imaging obtained time intensity curve(TIC):rise time (RT),half elution time and time to peaking (TTP)were significantly different between benign and malignant groups(P <0.05).While there was no significant difference of parameters as mean transit time (mTT)and arrived time (AT)(P >0.05).Conclusions CEUS had higher diagnostic accuracy than MRI in benign orbital tumor.The contrast enhancement intensity and time-intensity curves provide valuable diagnostic information for differential diagnosis of benign and malignant orbital tumor.

Objective To evaluate the effect of non-linear blending function for dual-energy CT on image of pulmonary angiogra-phy.Methods 27 patients underwent dual energy CT pulmonary angiography(CTPA).Data obtained with 100 kVp,140kVp,and non-linear blending were divided into group A,B,and C respectively.CT value of emboli were measured.Corresponding signal to noise ratio(SNR )and contrast to noise ratio(CNR)were calculated.One-way Anova analysis and Friedman test were used to ana-lyze statistical significance among these values.Results On quantitative analysis of 27 patients,there was no statistical difference for CT value of CTPA among the three groups(P >0.05).For the noise,CNR and SNR,there were statistically significant among the three groups(P <0.05).Conclusion The non-linear blending function has certain advantages in improved image signal-to-noise ratio and it can be used in CT pulmonary angiography examination for patients suspected pulmonary embolism clinically .

Objective To evaluate the application of CT myelography (CTM) in detecting the site of spontaneous cerebrospinal fluid (CSF) leaks and analyze it's imaging features.Methods Six patients (3 women and 3 men) with spontaneous intracranial hypotension (SIH) were included, who met the criteria of the International Headache Classification (2nd edition, 2004). Five patients subsequently underwent whole spine MRI and all 6 patients underwent CTM. Autologous blood mixed with omnipaque (300 mg/ml) was injected followed by selective puncture at the leak site indicated by CTM. Results MRI was failed to find leak site in the 5 patients, whereas CTM successfully found leak sites in all 6 patients. There were 1 to 7 leak sites respectively with an average of 4.2 sites (totally 25 points). Leak sites at cervical (12 sites) and thoracic (12 sites) were more frequent than at lumbar (1 site). CTM was featured by linear leakage of the contrast medium along the spinal nerve roots, paraspinal collections of hyper-density contrast medium and beak-like enlargement of the nerve sleeves. All patients responded well to the treatment, with complete resolution of symptoms. Conclusion CTM has been shown to be a study of choice to accurately define the location and extent of a CSF leak.

Objective To assess intraplaque hemorrhage before carotid artery stenting (CAS)by use of 3D-MPRAGE and DWI sequence.Methods Thirty-two symptomatic patients who had carotid artery plaque suspected by color Doppler ultrasonography and prepared for CAS underwent 3.0T carotid high-resolution MR scans,including regular sequence,T1-weighted gradient echo three-di-mensional magnetization prepared (3D-MPRAGE ) sequence,diffusion-weighted imaging (DWI ) sequences.According to 3D-MPRAGE sequence hemorrhage and non-hemorrhage groups were divided,and measured the mean ADC values of the two groups, hemorrhage and non-hemorrhage part in the hemorrhage group.Meanwhile preoperative cerebral hemorrhage group underwent brain DWI scans.Independent samples t-test analysis was utilized by SPSS V20.0 statistical software.Results High-resolution MRI dis-played 40 plaques,fourteen hemorrhagic plaques showed by 3D-MPRAGE sequence.The mean ADC values of hemorrhage and no-hemorrhage group were(1 233.5±283.5)× 10 -6 mm2/s,(1 688.9 ± 449.6)× 10 -6 mm2/s respectively,the difference of both was significant (t=3.43,P <0.05).The mean ADC values of hemorrhage and non-hemorrhage parts in the hemorrhage group mean ADC values were (934.0 ± 387.9)× 10-6 mm2/s,(1 313.9 ± 295.0)× 10-6 mm2/s respectively;the difference of both was statistically significant (t=2.92,P < 0.05 ).The difference of mean ADC values between non-hemorrhage part in the hemorrhage group and hemorrhage group was statistically significant (t=2.80,P <0.05).Conclusion 3D-MPRAGE and DWI sequences can be evaluated intraplaque hemorrhage before CAS,and provided a reliable basis for timely clinical interventions to prevent stroke.

Objective In this study,functional magnetic resonance imaging(fMRI)is performed to visualize what type of brain activity correlates with writer's cramp.Methods Ten patients with writer's cramp and ten age-and gender-matched control subjects participated in this study.fMRI block design is used.Subjects were scanned while performing three visually instructive tasks with MR Vision 2000:(1)suppositional writing;(2)writing with finger;(3)writing with a pencil.Data were analyzed with Analysis of Functional Neuroimaging(AFNI)software for groups of patients versus controls.Results Compared with controls,patients with writer's cramp showed greater activation of contralateral basal ganglion(especially the putamen,864 activated voxels in patients versus 54 in controls),ipsilateral cerebellar hemisphere,and contralateral sensorimotor,supplementary motor,premoter,primary sensory cortex in the task of writing with a pencil.There is no obvious difference in the task of writing compared with finger writing.Furthermore,these differences existed in the subtractive activated maps for “writing with pencil” minus “writing with finger”,while the activation of subcortical area and insula in controls disappeared.Conclusion These results indicate that the dysfunction of basal ganglion and subcortical-cortical loop might play a pathophysiologic role in the writer's cramp.

Objective: To compare the difference in somatic gene mutation of PTC subtypes between 114 patients with papillary thyroid carcinoma (PTC) and The Cancer Genome Atlas (TCGA) database. Methods: Totally 114 PTC patients admitted to The First Affiliated Hospital of Nanjing Medical University were recruited. The 18 hotspot genes associated with thyroid cancer were detected in thyroidectomy specimens were using next generation sequencing. PTC data were downloaded from the TCGA database in the cBioPortal website, and the difference in the somatic gene mutation was compared between 114 PTC patients and the TCGA database Results: The 114 PTC patients included 73 women (64.04%) and had a mean age of (39.23±13.18) years. The prevalence of BRAF V600E (66.67% vs. 48.68%), TERTp (3.51% vs. 0.41%), PDGFRA (1.75% vs. 0%), PTEN (3.51% vs. 0.41%) and TP53 gene mutations (4.39% vs. 0.61%) was significantly higher among the 114 PCT patients than in the TCGA database (P<0.05). The prevalence of BRAF V600E (80.88% vs. 54.99%), TP53 (7.35% vs. 0.57%) and TSHR gene mutations (2.94% vs. 0%) was significantly higher in classical PTC(CPTC) patients than in the TCGA database, and the prevalence of BRAF V600E (36.84% vs.13.86%) and TERTp gene mutations (10.53% vs. 0%) was significantly higher in follicular variant PTC (FVPTC) patients than in the TCGA database. According to the American Thyroid Association Risk Stratification of Thyroid Cancer Recurrence, the prevalence of BRAF V600E and TP53 gene mutations was 77.14% and 8.57% among moderate-risk CPTC patients, the prevalence of BRAF V600E gene mutation was 27.27% among low-risk FVPTC patients, and the prevalence of TERTp gene mutation was 33.33% among moderate-risk FVPTC patients, which were all higher than in the TCGA database (55.10%, 0%, 3.28%, and 0%, respectively; P<0.05). Conclusion There are significant differences in the type and rate of somatic gene mutations between 114 PTC patients and the TCGA database.

This study firstly reviews the history and current situation of course construction, then combines closely with the objectives and the summary of current situation of the standardized residency training, and finally puts forward concrete countermeasures from the several angles, such as teaching objectives, teaching team development, teaching content and forms, as well as evaluation mechanism, advocating the promotion of problem-based learning (PBL), medical simulation teaching (MST), literature discussion and other teaching methods, encouraging the integration of humanities education and clinical guidelines into teaching, and adopting objective structured clinical examination + standardized patient (OSCE+SP) assessment method and conducting two-way assessment, so as to assist in the education development of the standardized residency training.

Objective To evaluate the effect of hypoxic-ischemic time on reduction of hypoxic-ischemic brain injury by sevoflurane postconditioning in neonatal rats.Methods Two hundred and ten 7-day-old Sprague-Dawley rats (105 male,105 female),weighing 13-17 g,were randomly divided into 7groups (n=30 each) using a random number table:sham operation group (group Sham),hypoxia-ischemia group (group HI),and sevoflurane postconditioning at different hypoxic-ischemic time point groups (P0,P3,P6,P 12 and P24 groups).Immediately after ligation of the left common carotid artery,and at 3,6,12 and 24 h after ligation,the rats inhaled the mixed gas containing 2％ sevoflurane for 30 min in P0,P3,P6,P13 and P24 groups,respectively.The fatality was recorded within 7 days after establishment of the model.At 7 days after establishment of the model,the rats were sacrificed,the brains were removed,and the right and left cerebral hemispheres were weighed separately,and the left/right cerebral hemisphere weight ratio was calculated.The hippocampal CA1 region and posterior cingulate gyrus were isolated,and the ratio of density of normal neurons in the left to the right was calculated.Results Compared with group Sham,the left cerebral hemisphere weight,left/right cerebral hemisphere weight ratio,and ratio of density of normal neurons were significantly decreased,and the fatality rate was increased in the other six groups (P＜0.05).Compared with group HI,the left cerebral hemisphere weight,left/right cerebral hemisphere weight ratio,and ratio of density of normal ncurons were significantly increased in P0,P3 and P6 groups (P＜0.05),and no significant change was found in the parameters mentioned above in P12 and P24 groups (P＞0.05).Compared with group P6,the left cerebral hemisphere weight,left/right cerebral hemisphere weight ratio,and ratio of density of normal neurons were significantly increased in P0 and P3 groups (P＜ 0.05).There was no significant difference in the parameters mentioned above between group P0 and group P3 (P＞0.05).Conclusion Sevoflurane postconditioning performed within 6 h of hypoxia-ischemia can reduce hypoxic-ischemic brain injury,and it provides no cerebral protection if exceeding 12 h.

Objective To evaluate the ability of contrast-enhanced ultrasonography (CEUS)in differentiate reactive lymph node,metastatic lymph node and lymphoma.Methods In a prospective study CEUS was performed in 129 patients with cervical lymph node enlargement.The entire process were recorded and preserved in DICOM format.The results were registered with Sonoliver.The receiver operating characteristic curve (ROC curve)analysis was performed to find the corresponding cutoff values. The selected node was removed surgically and submitted for histology.Results Of all the nodes,26 were reactive nodes,85 were metastases and 1 8 were lymphoma.Enhancement pattern was the most accurate way to characterize lymph nodes.The enhancement pattern of reactive lymph nodes was homogeneous and most of them were enhanced by lymphatic type while the metastatic lymph nodes were inhomogeneously enhanced or weakly enhanced by peripheral type.Lymph node lymphoma usually had no fixed enhancement pattern. Arrive time (AT),rise time (RT),time to peak (TTP),mean transit time (mTT),maximum intensity (IMAX),under the curve (AUC),rising slope(Kup),semi descending slope(Kdown)and perfusion index (PI)were significantly different in the three groups(P <0.05).RT,TTP and mTT of reactive lymph nodes were the shortest,which had significant difference compared with those of metastatic lymph nodes and lymphoma (P < 0.05 ).Kup,Kdown,IMAX%,AUC,PI in the reactive lymph nodes were significantly decreased compared with the metastatic group (P <0.05),but there was no significant difference compared with those in lymphoma (P >0.05 ).When TTP≥ 7.74 s,mTT≥26.54 s,metastatic lymph nodes were considered.When RT≥4.62 s,TTP ≥ 7.74 s,mTT ≥ 28.32 s,reactive lymph nodes were not considered. Conclusions Dynamic contrast-enhanced ultrasound image and enhancement pattern can distinguish neck lymph nodes while the optimal cut-off point time of the time-intensity curve parameters can further contribute to the identification of lymph nodes.

Objective To determine whether the different pathological types of astrocytic tumours can be differentiated by diffusion tensor MR imaging. Methods In this study, diffusion tensor MR imaging was performed preoperatively in 67 patients with different pathological types of astrocytic tumours. Furthermore , T1WI, T2WI, FLAIR and T1WI enhancement scanning by GD-DTPA were performed preoperatively in all patients. The Mean diffusivity (ADC) values in the tumor parenchyma and normal white matter from different pathological types of astrocytic tumours were measured and analyzed. The ADC with the tumor parenchyma and normal white matter from the tumours were statistically analyzed by SPSS 19.0. The results were expressed as ± s and P < 0.05 was regarded as statistically significant differences. Results There were many differences with ADC (< 10-9 mm2/s) in the tumor parenchyma between fibrillary astrocytoma (1.48 ± 0.12、0.72 ± 0.05) from fat cell astrocytoma (1.31 ± 0.07, 0.69 ± 0.03), There were also many differences with ADC ( < 10-9 mm2/s) in the tumor parenchyma between fibrillary and fat cell astrocytoma from anaplastic astrocytoma (1.06 ± 0.11, 0.71 ± 0.04) and giant cell glioblastoma (0.98 ± 0.09, 0.73 ± 0.04). There were not differences with ADC in the tumor parenchyma between anaplastic astrocytoma from giant cell gliobastona. Conclusion Measurement of tumor parenchyma′s ADC values can identify different pathological types of astrocytic tumours , but not between anaplastic astrocytoma and giant cell glioblastoma. DTI is essential to preoperative evalution of astrocytic tumours.