Objective To compare the diagnostic performances of strain elastography (SE) and shear-wave elastography (SWE) in differentiating benign and malignant solid breast lesions. Methods From January 2015 to December 2015, 150 patients with 155 lesions were examined with SE and SWE respectively in the First Affiliated Hospital with Nanjing Medical University. Elasticity scores on a improved 5-point scale,strain ratio (SR), maximum elasticity (Emax), mean elasticity (Emean), standard deviation of the elasticity (Esd) and the lesion-to-fat elasticity ratio (Eratio) were assessed. The receiver operating characteristic (ROC) curve of SE and SWE parameters were plotted to assess the value in distinguishing benign and malignant breast lesions. The results were compared using the area under the ROC curve (AUC). The accuracy of the parameters with the largest AUC were compared between SE and SWE by McNemar test in different breast imaging reporting and data system (BI-RADS) categories. Results The AUC of elasticity scores, SR, Emax,Emean, Esd and Eratio were 0.823, 0.810, 0.877, 0.835, 0.881 and 0.853, respectively. The SE and SWE parameter with the largest AUC were elasticity scores and Esd respectively. The accuracy of Esd was higher than that of elasticity scores(86.3% vs 64.7%)in 4A lesions (2=4.639, P < 0.05). There were no significant differences in accuracy in other BI-RADS categories. Conclusions Both SE and SWE were helpful for the differentiation of benign and malignant solid breast lesions, and the diagnostic performance of SE and SWE was similar. The optimization of elastography can be achieved by combination with BI-RADS.

Objective: To observe the controlled hypotension effects of nicardipine in 2 different ways for spinal tumor operalion. Methods: Twenty-four adult patients, scheduled for selective spinal tumor operation, were randomly divided into 2 groups. In groupⅠ(n=12), the nicardipine was infused at a rate of 10 μg*kg-1*min-1 and the infusion continued until MAP was at the level of 7.33-8.66 kPa, and then the rate was decreased to 1 μg*kg-1*min-1. In Group Ⅱ(n=12), nicardipine was given 0.01-0.02 mg/kg as the load dose, then infused at 1-2 μg*kg-1*min-1. Results: During the period of controlled hypotension, cardiac index(CI) increased significantly, other hemodynamic variables were stable and no hypertension rebound occurred in both groups. Reaching time of target blood pressure in groupⅡ was shorter than that in groupⅠ（P＜0.05）. The dose required to obtain target blood pressure in group Ⅱwas less than that in group Ⅰ（P＜0.05）. BP recovery time from discontinuing nicardipine infusion to pre-hypotension level,bleeding volume and transfusion volume were similar between 2 groups（P＞0.05）.During mass bleeding,　serious arrhythmia and oliguria did not occur in any case. Conclusion: Controlled hypotension with nicardipine is rapid, stable and easily controlled without hypertension rebound. Nicardipine has considerable protective effects on heart and kidney during mass bleeding. The method of bolus injection followed with intravenous infusion is more suitable to clinical application.

Objective To evaluate the efifcacy and safety of Xiyanping in the treatment of hand-foot and mouth disease. Methods Based on the principles and methods of Cochrane systematic reviews, Cochrane Library, PubMed, Medline, Chinese Bio-medicine Database (CBM), China Journal Full-text Database (CNKI), VIP database and Wanfang database were searched. All of the randomized controlled trials (RCT) of Xiyanping versus ribavirin were included. The data were extracted and evalu-ated by two reviewers independently. Risk assessment tool was used to assess the risk of bias and software Revman5.0 was used for meta-analysis. Results Twenty-four RCT and 3314 patients were included. Comparing to ribavirin, Xiyanping showed better therapeutic outcomes regarding to total effective rate, durations of fever and rash elimination (RR=1.17, 95%CI:1.12~1.23;MD=-1.56, 95%CI:-2.10~-1.02;MD=-1.41, 95%CI:-1.90~-0.93). Side effects were rare in both groups and could be recovered after drug withdrawal. Conclusions The current evidence suggests that Xiyanping is superior to ribavirin in the treatment of hand-foot and mouth disease.

Objectives To explore the relevant factors of liver X receptor (LXR) and lipid metabolism in school-age chil-dren with obesity. Methods A total of 80 obese children were selected by indexes of physical growth from pupils in Grades 1-6, aged 7-14 years from June 2011 to October 2011. Fifty-one age and sex matched children with normal BMI were chosen as nor-mal controls. The metabolic indexes including aspartate transaminase (AST), alanine aminotransferase (ALT), glutamyl transpep-tidase (GGT), total cholesterol (CHOL), triacylglycerol (TG), high density lipoprotein cholesterol (HDL-C), low density lipopro-tein cholesterol (LDL-C) and expression of LXR were detected in fasting blood. Results The expression level of LXR in obese children (9.14 ± 1.15) was higher than that in control children (2.84 ± 3.68) with significant difference (t=4.55,P=0.000). Eighty percent (80%) of obese children were LXR>1 (64/80) which was higher than that of control children (23/51, 45.1%), and signifi-cant difference was found between the two groups (χ2=17.01, P=0.000). Compared to controls, the levels of AST, ALT, GGT, CHOL, TG and LDL-C were higher while the level of HDL-C was lower in obese children (P<0.05). The correlation analysis found that AST, ALT, CHOL, LDL-C and BMI were positively correlated with LXR (r=0.18~0.26,P<0.05). Logistic regression ana-lysis showed that AST≥40IU/L (OR=1.076), ALT≥40IU/L (OR=1.036), CHOL≥5.20 mmol/L (OR=2.038), LDL-C≥3.36 mmol/L (OR=2.176) and BMI≥18.9 kg/m2 (OR=1.131) were risk factors for LXR>1 (P<0.05). Conclusions Obesity in school-age chil-dren can up-regulate the expression of liver X receptor and cause liver damage and abnormal lipids metabolism.

The effect of gelatin on anaero-cultivation of Bifidobacterium adolescent is and stabilization of its living cell in dried preparation was investigared. It was shown that the well-distributed mixture of gelatin and medium could have a cushioning effect on pH reduction resulting from acid-production while incubating, and the dried mixture comprising living cell of bifidobacterium adolescentis was prepared, in which the stability and viability of cell come from cultures of gelatin mixture was increased compared with that without gelatin mixture. It was shown that oxygen toxicity to anaerobic cell was well reduced because of cell immobilization by the gel mixure after drying with saccharide substance , and then fermentable dynamics in 50L fermentor was tested as well as the relationship of growth kinetics, pH, dissolved oxygen rate, and content of soluble solids.

Objective To investigate the association between different number of inferomedial screws (0-3 screws) and their efficacy in locking plate of proximal humerus fractures.Methods Data of 90 patients who had undergone locking plate for proximal humerus fracture between January 2007 and December 2012 were retrospectively analyzed.They were divided into four groups according to the number of inferomedial screws.In the NS (no-screw support) group,36 patients did not have inferomedial screws for mechanical support of the inferomedial region of the proximal humerus; in the OS (one-screw support) group,23 patients had the reconstruction by insertion of only one inferomedial screw; there were 19 patients in the TS (two-screw support) group and 12 in the ThS (three-screw support) group.There were no significant differences among 4 groups in sex,fracture type and age.The Constant scores of the shoulder function,changes in humeral head height at the latest follow-up,incidence of complications and time for fracture healing among the 4 groups were collected.Results The follow-ups for the patients ranged from 12 to 56 months (mean,21.4 months).At the latest follow-up,the ThS,TS,OS and NS groups had a mean Constant score of 76.7 (SD,11.6),74.1 (SD,7.4),66.8 (SD,10.7),65.8 (SD,10.2),respectively; the mean change in humeral head height were 1.4 (SD,1.0) mm,2.9 (SD,1.2) mm,5.3(SD,3.2) mm and 6.7(SD,3.3) mm,respectively.There were no significant differences between the ThS and TS groups in Constant score,and Constant scores in ThS and TS groups were significantly higher than those in OS and NS groups.However,the loss in humeral head height in the ThS group was significantly less than those in the TS,OS and NS groups,and the loss in humeral head height in TS group was significantly less than those in the OS and NS groups.There were no significant differences among 4 groups in time for fracture healing and incidence of complications.Conclusion Locking plate in general do not appear to be a panacea for proximal humerus fractures especially in cases of medial comminution or bone defects because of the malreduction of the medial cortical bone.However,medial support with two or three inferomedial screws being meticulously placed in the inferomedial region may enhance the mechanical stability of medial column support and allow for better maintenance of reduction.

Objective: To investigate jugular bulb venous oxyg en partial pressure(PjO2)， hemoglobin saturation (SjO2) and the arterial t o jugular bulb venous oxygen content difference(AjDO2) during anesthesia with desflurane and isoflurane in patients with brain tumor. Methods: Fifty-six patients with brain tumor were randomized into desflur ane or isoflurane for maintaining anesthesia. PjO2, SjO2 and AjDO2 in pati ents were measured during normoventilation, hyperventilation and hypoventilation . Results: During normoventilation， SjO2 and PjO2 in desflu rane group was significantly higer than those in isoflurane group（P<0.05 or P<0.01）, and AjDO2 in desflurane group was significantly lower than that in isoflurane group（P<0.05）.Except that PjO2 in desflurane group was si gnificantly higer than that in isoflurane group during hyperventilation （P< 0.01）, there were no differences in SjO2, PjO2 or AjDO2 between the 2 g roups during hyperventilation or hypoventilation. While anesthesia with desflura ne and isoflurane, there was a positive correlation between PaCO2 and SjO2. Conclusion: At the same anesthetic effect concentration, desflur ane can significantly increase SjO2 and PjO2 in comparison to isoflurane un der normoventilation, suggesting that desflurane may have stronger effect of rel axing cerebral vessel than isoflurane.

Objective To investigate the efficacy and safety of hypertonie saline enhanced radiofrequency ablation (RFA) in the treatment of liver cancer. Methods The clinical data of 42 patients with primary liver cancer (n = 28) or metastatic liver eancer (n = 14) who had been admitted to First Affiliated Hospital of Nanjing Medical University from September 2001 to December 2007 were collected. Forty-eight lesions were detected with a diameter ranging from 1.2 cm to 7.5 cm. RFA electrode and 20G needle were pricked into the target lesion under the guidance of B ultrasound or computed tomography (CT) through percutaneoas puncture or open approaches. An amount of 5-10 ml hypertonie saline was infused through the needle at regular intervals during RFA. All patients were followed up for 3-79 months. Contrast-enhanced ultrasound and CT scanning were performed postoperatively to determine the efficacy of RFA. The levels of alpha-fetoprotein (AFP) before and after treatment were compared using t test, and the survival of the patients were analyzed using a Kaplan-Meier survival curve. Results The AFP expression changed to negative in 14 out of the 18 AFP-positive patients, with statistical difference (t =7.703, P <0.05). The complete necrosis rate of tumors was 94% (45/48), and the necrosis rate of tumors with diameter of ≤4.0 cm reached 100% (35/35). The incidence of complication was 5% (2/42). No perioperative mortality occurred. The 1-, 2-, 3-year survival rates were 91%, 85% and 70%, respectively. Conclusions Hypertonic saline enhanced RFA in the treatment of liver cancer was proved to be safe and effective.

Objective To explore the application value of ultrasound-guided fine needle aspiration biopsy(FNAB) in diagnosing thyroid nodules of TI-RADS 4-6 categories.Methods A retrospective analysis was made on the pathologic data of 494 patients (totally 501 nodules) who underwent TI-RADS ultrasonographic stratification and ultrasound-guided FNAB.168 thyroid nodules of TI-RADS 4-6 categories were selected from 163 patients and classified into three groups:group T,TI-RADS 4A categories;group Ⅱ,TI-RADS 4B category; group Ⅲ,TI-RADS 5-6 category(the pathologically confirmed cases in category 6 had been removed).The ultimate pathologic findings were taken as golden standards to calculate the accuracy,sensitivity,specificity,positive predictive value of ultrasound-guided FNAB in the three groups.ROC curve was drawn to evaluate the diagnostic value of FNAB.Results The accuracy,sensitivity,specificity,positive predictive value of the ultrasound-guided FNAB in the three groups were listed as follows:group Ⅰ 74.4％,73.3％,75.0％,64.7％;group Ⅱ 83.9％,87.5％,71.4％,91.3％;group Ⅲ 89.3％,91.7 ％,75.0％,95.7 ％ respectively.The positive predictive values of the ultrasound-guided FNAB for group Ⅰ and group Ⅱ was higher than that of conventional TI-RADS classification criteria,so the difference was statistically significant; while the positive predictive values for group Ⅲ was close to the conventional ultrasound TI-RADS classification criteria,the difference was not statistically significant.Conclusions The combination application of TI-RADS classification criteria and FNAB can improve the accuracy of ultrasound diagnosis in group Ⅰ and group Ⅱ,and reduce the puncture rate of group Ⅲ.

BACKGROUND:Studies have shown that the vacuum sealing drainage technology can effectively promote the wound healing, and it has a wide prospect of clinical application, but there are few reports addressing the
treatment of diabetic foot.
OBJECTIVE:To discuss the clinical effect of vacuum sealing drainage technology in the treatment of diabetic foot wounds.
METHODS: Sixty diabetic foot patients were randomly divided into two groups: traditional treatment group,
regulating blood sugar level, dressing and traditional debridement; vacuum sealing drainage group, conventional treatment combined with the vacuum sealing drainage technology. The clinical efficacy of two treatments for
diabetic foot was evaluated.
RESULTS AND CONCLUSION: Compared with the traditional treatment group, the vacuum sealing drainage
showed better outcomes in switching frequency, stable blood sugar control, preparation time, wound healing time and cure rate (P < 0.05). It indicates that the vacuum sealing drainage technology in the treatment of diabetic foot ulcers can resolute wound inflammation, stimulate the growth of granulation, create a favorable surgical condition for secondary skin grafting or flap coverage, significantly shorten the treatment time, and exhibit better curative effects than the traditional treatment.