Objective To investigate the types of ultrasonographic appearance of post-hepatectomy in operative position. Methods The data about operative manner,operative position, type of plugger in residul cavitity of 176 cases who underwent hepatic operation,were collected. Their ultrasonographic findings of post-operative liver in operative position in different phrases after operation were analyzed retrospectively. Results The main appearance was: ① Absence of partial hepatic lobe or hepatic segment; ② anechoic area with thin wall or mixed mass in operative position; ③ conformation of irregular high-echo conglomeration in operative position, irregular wall thickeness and inhomogenous internal echoes appeared in anechoic area and mixed mass in operative position, color Doppler twinking artifact appeared around some plugger and residual cavity which made by curettage and aspiration technique with time passing by. Conclusions Ultrasonographic appearance of post-hepatectomy in operative position varies with different operative manner, operative position, resected area, and Absence or existence of plugger in residual cavity, different type of plugger in residual cavity.

Objective To evaluate the value of high frequency color Doppler ultrasound in diagnosis of malignant tumor in the parotid gland.Methods High frequency ultrasound was used to observe shape and internal echo texture of tumor,color Doppler flow imaging(CDFI) was added to observe blood flow signal,peak systolic velocity(PSV) and resistance index(RI) were measured by pulsed wave Doppler, and lymphonodus around parotid gland were examined.Results The features of ultrasonography included round,lobulated and irregular shape.Three types of boundary were clear but not smooth,unclear,irregular and invasive.Internal echo texture included low and irregualr echo,cystic echo,spot like and intensive echo,honey comb like echo.CDFI showed spet like,stick like blood flow signal.PSV and RI were 4.6 17.5 cm/s,and 0.69 1.14 .Eight cases were misdiagnosed for benign tumor,the correspondent rate was 87.1% .Conclusions The high frequency ultrasonogram of malignant tumor in the parotid gland were similar and specific,adding the CDFI,PSV,RI and lymphonodus examination around the parotid gland may help to improve the diagnostic accuracy.

BACKGROUND:Internal fixation is commonly used in an early stage of intertrochanteric fractures of the aged worldwide, and can apparently reduce complications and fatality rate. The commonly used internal fixators contain proximal femoral nail anti-rotation and dynamic hip screw, whose comparison is current research hotspot.
OBJECTIVE: To evaluate the hip function and stability after internal fixation with proximal femoral nail anti-rotation and dynamic hip screw in repair of intertrochanteric fractures of the aged.
METHODS:A total of 64 aged patients with intertrochanteric fractures were enroled in this study, and assigned to dynamic hip screw group (n=30) and proximal femoral nail anti-rotation group (n=34). The fracture reduction and healing were evaluated using anterioposterior and lateral X-ray films. Operation time, intraoperative blood loss, complication rate, healing time and postoperative hip function were compared and analyzed between the two groups, and then assessed in accordance with Sander’s scoring system.
RESULTS AND CONCLUSION:Compared with dynamic hip screw group, operation time, intraoperative blood loss, healing time and complication rate after treating unstable intertrochanteric fracture (Tronzo-Evans III, IV and V types) showed significant advantages in the proximal femoral nail anti-rotation group (P < 0.05). Hip function restored better, and the complication rate of stable intertrochanteric fracture (Tronzo-Evans I and II types) was lower after treatment in both groups (P > 0.05). These data show that the effects of proximal femoral nail anti-rotation were better than that of dynamic hip screw for treatment of intertrochanteric fractures, and hip function recovered better. Moreover, proximal femoral nail anti-rotation had biomechanical stability, especialy for unstable fracture.

Through the doctor group, the questionnaire survey to understand what the doctor online habits situ-ation of network communication, doctors and patients, the effect of the real network environment for medical diag-nosis and treatment, news media under the network environment on the influence of the doctor and the doctor group about web development comprehensive view of the impact of the doctor-patient relationship.Points out that the current network environment brings to the doctor-patient relationship: the influence of the Internet become some doctors information update and the accumulated knowledge source, network has become an important platform inter-action some doctors and patients, doctors need to deal with an increasing number of network patients, the doctor-shave reactive shifts to the media negative reports.

[Abstract ] Enhanced recovery after surgery (ERAS) is a kind of multi-discipline technology which is based on evidence-based medicine and aims to optimize the current peri-operative management, reduce the stress and complications during the periopera-tive period and enhance recovery aftery surgery.The introduction and successful practice and generalization of ERAS promote the trans-formation of medical quality management thought, innovation of the clinical technologies and patients'rehabilitation process.In the era of ERAS, we should make efforts to promote the medical quality management by fully using new technologies from the aspects of impro-ving the understanding, strengthening team work and optimizaing information support.

BACKGROUND:The non-specific immune suppression method is generaly used for treatment of systemic lupus erythematosus, but poor prognosis, such as infection and high recurrence rate, exists.
OBJECTIVE:To evaluate the therapeutic effect of bone marrow mesenchymal stem cel transplantation on systemic lupus erythematosus in mice.
METHODS:Sixteen mice with systemic lupus erythematosus were equivalently randomized into control and experimental groups, or then subjected to passage 3 bone marrow mesenchymal stem cel transplantation or the equal volume of normal saline via the tail vein, respectively. Mouse urine samples were colected to detect urine protein levels by Bradford method. Blood samples from the tip of the mouse tail were extracted to detect serum anti-ds-DNS antibody concentration by radioimmunoassay. Mouse kidney tissues were taken and observed pathohistologicaly through hematoxylin-eosin staining and immunohistochemistry staining under microscope. Flow cytometry was used to detect the expression of CD4+CD25+T cels in the inner canthus blood, fresh spleen and thymus.
RESULTS AND CONCLUSION:Within 10 weeks after cel transplantation, the urine protein levels in the two groups were gradualy increased, and the rising velocity was higher in the control group than in the experimental group. From the 4th to 10th week, the urine protein levels in the experimental group were significantly lower than those in the control group (P < 0.05). In the control group, lymphocyte infiltration was visible in the kidney tissues with a few of plasmocytes, and pathological findings showed the mice presented with interstitial nephritis; in the experimental group, the mice had no pathological changes in the kidney. In the two groups, immune complexes were found in the mesangial area, which showed a patch-like distribution in the control group and a punctate distribution in the experimental group; the relative proportion of the occupied area in the experimental group was significantly lower than that in the control group. The expression level of CD4+CD25+T cels in the blood and thymus were significantly higher in the experimental group than the control group (P < 0.05), and the expression level of CD4+CD25+T cels in the spleen was slightly higher in the experimental group than the control group with no significant difference (P > 0.05). The serum anti-ds-DNA antibody concentration in the experimental group was significantly lower than that in the control group (P < 0.05). Taken together, bone marrow mesenchymal stem cel transplantation can improve the pathological damage in systemic lupus erythematosus mice, and has a certain therapeutic effect on systemic lupus erythematosus.

Objective To study the theraputic effect of cyclophosphamide,glucocorticoid combined with sildenafil on pulmonary hypertension in systemic lupus erythematosus(SLE?PAH) patients,and to analyze the prognosis adverse factors. Methods Forty?six cases patients with SLE?PAH from Tangshan Gongren Hospital from January 2009 to January 2015 were selected as research subjects. All patients were treated with prednisone, cyclophosphamide and sildenafil,and the course of treatment was 24 weeks. The treatment effect was observed, the systemic lupus erythematosus disease activity score(SLEDAI),6 minutes walk distance and heart function before and after the treatment were compared. The effective and uneffective patients'clinical and test information were compared,and the prognosis adverse factors were analyzed. Results After 24 weeks treatment,the total ef?fective rate was 78. 3%(36/46). Pulmonary artery systolic pressure(PASP) dropped from (59±16) mmHg be?fore treatment to (45±15) mmHg after treatment,there was significant statistical difference(t=-4. 539,P<0. 01). SLEDAI dropped from (6. 6±2. 3) points to (2. 4±0. 8) points,,there was significant statistical differ?ence(t =11. 680,P<0. 01). The 6 minutes walk distance rose form (402±96) minutes to (465±97) minutes, there was significant statistical difference( t=-3. 137,P<0. 01) . Cardiac function improved significantly,there was significant statistical difference( P<0. 01) . There were 10 cases uneffective and deterirated patients,with the age of (42±6) years,36 cases effective patients with the age of (33±4) years,the difference was statistically significant( t=-5. 423, P<0. 01 ) . Uneffective and deterirated patients' anti?RNP antibody positive rate was 90. 9%( 9/10 ) , significantly higher than the effective patients ( 52. 8%( 19/36 ) ,χ2 = 4. 552, P<0. 01 ) . Conclusion Cyclophosphamide, glucocorticoid combined with sildenafil has obvious effect on patients with SLE?PAH. PASP,heart function and 6 minutes walk distance are the important indicators of prognosis. Anti?RNP antibody and age are the adverse prognostic factors.

Objective To evaluate the significance of sonographically detected thyroid calcification in the diagnosis of thyroid carcinoma.Methods Five hundred and twenty-two patients with thyroid disease,including 119 with thyroid cancer,were included in the study.Each patient underwent preoperative,highresolution sonography to evaluate the thyroid gland for the presence of calcification.Calcifications were classified:type Ⅰ,microcalcification;type Ⅱ,coarse calcification;type Ⅲ,annular or"egg-shell"calcification;typeⅣ,calcified nodules within a cyst.Results The incidence of calcification and microcalcification was significantly higher in thyroid cancer than in benign nodules(P＜0.001).The appearance of microcalcifications was highly specific for malignancy with a sonographic specificity of 88%.The sensitivity was 60%,and the odds ratio(0R)was 11.28.The incidence of calcifications of type Ⅱ and type Ⅲ did not differ significantly between the benign and malignant groups.Calcifications of type Ⅳ were showed totally in benign groups.Patients younger than 45 years with calcified nodules constituted a highrisk group,with a OR of 11.33 versus 2.96 in patients older than 45 years with calcified nodules.In the group of solitary thyroid nodules,the incidence of cancer in the calcified nodules was higher than in the nodules without calcifications,with a OR of 20.48.Conclusions The detection of thyroid calcifications by sonography is diagnostically valuable,especially in eases involving a solitary nodule or a young person.The presence of calcifications in these cases should raise the suspicion of malignancy,especially microcalcification.