Objective To compare the diagnostic value between ultrasound radiography with enhanced CT in patients with focal liver lesions.Methods 80 patients with focal liver lesions were enrolled.They were detected through ultrasound radiography and enhanced CT.Results In 80 patients,there were 21 cases with primary liver cancer,18 cases with metastatic cancer,20 cases with hepatic hemangioma,11 cases with focal hepatic fatty infiltration,7 cases with hepatic focal nodular hyperplasia and 5 cases with liver hardening of nodules.17 patients with metastatic cancer were diagnosized through ultrasound radiography and 16 cases were diagnosized through enhanced CT.7 patients with hepatic focal nodular hyperplasia were diagnosized through ultrasound radiography and 6 cases were diagnosized through enhanced CT.There were no significant differences in the diagnostic results between the two groups (x2 =0.0379,0.0835,all P ＞ 0.05).Conclusion There are different enhanced modes in ultrasound radiography for different nature of focal liver lesions,which has a equal diagnostic value with enhanced CT.

Objective To investigate the effect of radiotherapy on carotid plaque ulcer formation by using ultrasound imaging.Methods Totally 93 cases diagnosed with head and neck cancers which had complete carotid ultrasound data and other baseline data before and after radiotherapy (RT) were retrospectively enrolled.The total number of plaques,average intima-media thickness,maximum plaque area,total number of ulcer plaques,maximum ulcer plaque area and the maximum area of the ulcer pit were compared in RT side and non RT side before and after RT respectively.Results The average interval time was 6.1±1.9 years between twice RT.Before RT,there were no statistical differences between RT side and non-RT side in the total number of plaques,the average intima-media thickness,maximum plaque area,total number of ulcer plaques,maximum ulcer plaque area and maximum area of the ulcer pit.After RT,compared with those of non-RT side,there were more lesions of the total number of plaques,the thicker average intima-media thickness,the larger maximum plaque area,the more maximum number of ulcer plaques,the larger maximum ulcer plaque area and maximum area of the ulcer pit in RT side,which had statistical defference (all P＜0.05).Conclusion RT can lead to the formation and progression of carotid atherosclerotic plaque in patients with head and neck cancers,and the plaque has a vulnerability characteristics.

Objective To investigate the value of multipoint and multidirectional ultrasound-guided fineneedle aspiration cytology (US-FNAC) in preoperative diagnosis of papillary thyroid microcarcinoma (PTMC).Methods From Jan.2012 to Jan.2013,multipoint and multidirectional US-FNAC were performed in 177 patients with 233 nodules suspected as PTMC,and the cytopathological findings were compared with surgical pathological results and clinical follow-up results.Results Of the 233 biopsies,the cytology were classified as malignant for 146 lesions,suspicious for malignancy for 43 lesions,benign for 24 lesions,follicular lesions for 4 lesions and inadequate sample for 16 lesions.After the second multipoint and multidirectional US-FNAC,only 1 case did not have sufficient cells for diagnosis,and the puncture failure rate was 0.43％.Actually there were 189 malignant and 44 benign lesions confirmed by clinical follow-up and pathological results.The sensitivity,specificity,and accuracy of multipoint and multidirectional US-FNAC was 99.5％,81.8％ and 96.1％ respectively.Conclusions Multipoint and multidirectional US-FNAC has definite value in increasing puncture qualified rate and positive diagnosis rate before operation.

BACKGROUND: Hyperuricemia (HUA), serving as a component of metabolic syndromes (MS), has a major regulatory role in inflammatory responses. However, the correlation between G-308A tumor necrosis factor-α (TNF-α) and MS is still controversial.OBJECTIVE: To study the correlation among G-308A TNF-α genotype distribution, TNF-α mRNA expression and C-reactive protein (CRP) in patients with HUA.DESrGN: Patients with HUA were selected as the subjects, while normal peoplewere taken as the controls.SETTING: Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology.PARTICIPANTS: Subjects were selected from 5 003 people, including 188 patients with HUA and 51 healthy people.Patients with HUA included 40 patients with simple HUA, 42 patients with HUA and dyslipidemia, 80 patients with HUA and dyslipidemia and hypertension, and 26 patients with gout (administration of allopurinol was stopped at one week before the experiment).METHODS: TNF-α gene promoter G-308A genotype was determined by using PCR application followed by Nco/digestion.TNF-α mRNA expression was studied by RT-PCR with semi-quantitative analysis. Antibody sandwich method and enzyme linked immunosorbent assay (ELISA) were adopted to determine the CRP concentration. And the serum uric acid was measured by uricase method, while the insulin resistance index (IRI) was evaluated with homeostasis model.MArN OUTCOME MEASURES: ① Hardy-Weinberg equilibrium test of genotypic frequency. ② Changes in distribution of G-308A TNF-α genotypes and TNF-α mRNA expression in patients with HUA. ③ Changes in TNF-α mRNA expression and other parameters in G-308A TNF-α AA+GA and GG groups. ④ Multiple stepwise regression analysis.RESULTS: A total of 188 patients and 51 normal people were involved in the analysis of results. ① G-308A TNF-α genotypes distribution in 239 enrolled subjects accorded with Hardy-Weinberg equilibrium. ② AA+GA was compared with GG due to lower frequency of AA in population. The results revealed the HUA with dyslipidemia and hypertension group displayed a greater prevalence in G-308A TNF-α AA+GA genotype (30%) than that in the control group (12%) (P ＜ 0.05),while there were no significant differences among other groups. ③ TNF-α mRNA expression and CRP concentration were the highest in the gout group, and HUA accompanied by dyslipidemia and hypertension group listed the second,and then was the HUA and dyslipidemia group, while simple HUA group listed the last, all of which were higher than those in the normal control group (P ＜ 0.05-0.01). TNF-α mRNA expression in HUA accompanied by dyslipidemia and hypertension group, gout group was higher than that in the normal control group (P ＜ 0.05-0.01). The WHR, SBP, DBP,serum uric acid, triglycerides, TNF-α mRNA expression and CRP concentration in AA+GA group were remarkably higher than those in the GG group (P ＜ 0.05-0.01). ④ After adjustment of age, gender, systolic pressure, diastolic pressure,fasting blood glucose, and multiple variable linear stepwise regression showed that triglycerides, uric acid, TNF-α 308 A carrier were related with quantityof TNF-α mRNA expression. Meanwhile, the uric acid concentration, WHR and the quantity expression of TNF-α were significantly in positive association with CRP concentration.CONCLUSTON:The genotype of TNF-α 308 A carriers is associated with TNF-α expression and plasma CRP levels in HUA patients.

Objective To assess the efficacy of early detection of breast cancer and the prognostic value of breast self-examination(BSE).Methods Randomized controlled trials(RCTs)involving BSE were included the present meta-analysis based on their qualities.The pooled analysis was performed with RevMany 4.2.8.Results Three RCTs were identified and then they were included the present metaanalysis.In women who conducted a BSE.the rate of biopsy fora lump in breast was 1.27%in the first 5 years,2.47%in more than 5 years but less than or equal to 10 years,and 2.50%in more than 10 years, respectively,all of which were significantly higher than in those who could not conduct a BSE(P<0.05) There was no significant difierence in the rate of final diagnosis and the mortality for breast cancer between the two populations in any follow-up time(P>0.05).Conclusion The rate of biopsy for a lump in breast in women could be increased by a BSE.which should not have been discarded from the early detection of breast cancer completely despite it is not helpful in increasing the rate of final diagnosis and decreasing the mortality for breast cancer.

Objective To investigate the effects of eye movement desensitization and reprocessing (EMDR) versus cognitive behavior therapy (CBT) for treating adult posttraumatic stress disorder (PTSD) .Methods A total of 81 patients with PTSD con‐forming to the including standard were randomly allocated to the EMDR group ,CBT group ,and control group ,27 cases per group . The PTSD symptoms ,anxiety and depression moods in 3 groups were assessed before and after treatment by adopting the Clinician‐administered PTSD Scale (CAPS) ,Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) .Results The drop‐out rates were 29 .63% for the EMDR group ,7 .41% for the CBT group and 7 .41% for the control group respectively ;the re‐experience symptoms score of CAPS in the EMDR group was lower than that in the CBT group with statistical difference (P=0 . 036) .Conclusion Both EMDR and CBT are the effective psychological therapeutic method ,EMDR has more effective than CBT in the reproving the re‐experience symptoms of PTSD .The future studies should pay more attention to the application of stabilization technologies for reducing the dropout rate of EMDR .

OBJECTIVE:To establish a pharmacy online to offline (O2O) platform service quality evaluation model,and to provide reference for platform operators to improve the service quality. METHODS:Using SERVQUAL scale,combining the situa-tion of pharmacy O2O platform development in China,the reliability,safety and aspects of O2O platform were analyzed to sum up primary evaluation index of pharmacy O2O platform service quality. Based on this,the expert interviews questionnaire was de-signed. According to the questionnaire results,indicators were modified and empowered to construct the pharmacy O2O platform service quality evaluation model;the reliability and validity of model were validated. RESULTS & CONCLUSIONS:According to the connotations of each dimension analysis in the SERVQUAL scale and expert interview results of pharmacy O2O platform ser-vice quality,pharmacy O2O platform service quality evaluation model is constructed,including five indicators as“reliability”“se-curity”,and 18 secondary indexes as the“number of platform pharmacy”“pharmacy qualification show”“pharmacy type”. The re-sults of model index reliability and validity verification show that model construction is reasonable and can provide reference for platform operators improving service quality. Follow-up research should give full consideration to the Chinese consumer behavior habits,personal preferences and other factors to build more suitable pharmacy O2O platform service quality evaluation model in China.

Objective To observe the clinical effects of Dexmedetomidine in combination with Sevoflurane for hysteroscopic resection. Methods 72 patients underwent hysteroscopic resection from January 2014 to December 2015 were divided into study group and control group according to the anesthesia mode. Patients in study group were in combination anesthesia mode of intravenous infusion of Dexmedetomidine and Sevoflurane inhalation, while patients in control group received Sevoflurane inhalation only. The clinical parameters and adverse reactions were observed and studied. Results Compared with control group, significant differences were shown in patients heart rate at T2, T3 and T4 and breathing rate at T2 in observation group (P < 0.05). Compared with T1 phase, there was statistical significance in study group patients systolic blood pressure (SBP), diastolic blood pressure (DBP), RR at T2, HR at T3, T4 (P < 0.05); Compared with control group, patients in study group had short onset time of anesthesia and long recovery of consciousness, while there has no statistical significance of the two groups (P > 0.05). Compared with control group, the respiratory depression, sedative effect of Ramsay sedation score, wakefulness, alertness / sedation score of observation method (OAA/S), digital pain score (NPRS), postoperative uterine contraction pain score, postoperative nausea and vomiting of study group had significant statistical differences (P < 0.05). Conclusion Combination anesthesia mode of intravenous pumping Dexmedetomidine and inhalation of Sevoflurane has good clinical effects for patients undergoing hysteroscopic resection.

Objective To identify the value of multiparametric MR imaging features including diffusion weighted (DW) and dynamic contrast-enhanced (DCE) MR imaging features in differentiation between inverted papilloma and malignant transformation of inverted papilloma in the sinonasal region.Methods Seventy-seven patients were included in this study,including 12 malignant transformation of inverted papilloma and 65 inverted papillomas.Conventional MRI including nonenhanced and static contrast-enhanced imaging,DCE-and the DW-MRI were analyzed.Differences in conventional MRI features,ADCs and DCE-MRI parameters between the two entities were determined by Fisher exact test,independent samples t-test and Mann-Whitney U test,respectively.Results There were significant differences in convoluted cerebriform pattern (P=0.045),necrosis (P=0.003) and orbit involvement (P＜ 0.01) between inverted papilloma and malignant transformation of inverted papilloma in the sinonasal region.The ADCs of inverted papilloma were significantly lower than those of malignant transformation of inverted papilloma (P＜0.01).There were significant differences in time to peak enhancement (P＜0.01),maximum contrast index (P=0.004) and time intensity curve types (P＜0.01) between the two entities.Conclusions A multiparametric approach using conventional MR imaging with added ADCs and DCE-MRI parameters had the potential to improve the differentiation between inverted papilloma and malignant transformation of inverted papilloma in the sinonasal region.

Anesthesia safety plays an important role in the medical safety of the perioperative.At present the medical institutions in many countries apply crew resource management model for training and assessment in anesthesiology,surgery and emergency.It emphasizes the training of nontechnical skills,called crisis resource management(CRM).This article analyzes the causes of human error incidents and preventive measures and introduces CRM principles in medical principles and anesthesia correlation and applications.CRM helps to foresee the crisis of environment and deal with the crisis source to ensure the safety of patients.