Objective To assess the value of contrast enhanced ultrasound (CEUS) in diagnosing subtypes of postpartum placenta accreta.Methods 31 puerperal clinically diagnosed of postpartum placenta accreta were collected.They were inspected by using CEUS and 2-dimensional color Doppler ultrasound,respectively.The operation was used as a reference.Results Both 2-dimensional color Doppler and CEUS could identify the sizes of residual placenta for the patients,but CEUS showed more explicit boundary for placenta and uterus and the rich/poor blood flow areas in the placenta.Among the 31 patients,7,23 and 1 were classified of accreta,increta and percreta,respectively,by using 2-dimensional color Doppler ultrasound,while 11,16 and 4 were classified of accreta,increta and percreta,respectively,by using CEUS based on the myometrial thickness and contrast agent subsided time.With respect to operation,10 patients were confirmed of accrete,with the other diagnosed of increta and percreta.The misclassification rate of 2-dimensional color Doppler ultrasound was 19.6 ％,while CEUS had only 6.5 ％.CEUS had a good agreement with operation (Kappa =0.859,P ＜ 0.001).Conclusions CEUS has higher accuracy in diagnosing subtypes of postpartum placenta accrete compared with 2-dimensional color Doppler ultrasound.CEUS can increase the accuracy and reliability for diagnosing those who were clinically considered of postpartum placenta accrete,and can provide helpful guidelines for clinical treatment.

Objective To establish the model and software for quality assessment of fetal nuchal translucency ultrasound image using computer image recognition technology.Methods The proposed approach firstly divided the input image into four sub-image blocks:the nasal bone(NB) area,the nuchal translucency (NT) area,the midbrain area,and the jaw and chest area.For each sub-image block,the algorithm compared the image block with the corresponding area of the standard training image set,and then determined whether the current image block was the qualified one using the the Gabor feature and Bayesian decision.The input ultrasound image was determined to be qualified only if it had four qualified sub-image blocks.Results The difference between our automatic method and the manual screening by experts wasting small,the method obtained Kappa =0.795 and P ＜0.001.Moreover,the efficiency of our method was much higher than the manual screening method.Conclusions Image recognition technology can effectively assist the sonographer to assess the quality of fetal NT of ultrasound image.The proposed approach can reduce the subjectivity and randomness of the manual evaluation of NT image.

Objective To investigate the feedback of eight-year program students to problem-based learning ( PBL ),and find out the existing problems and solutions.MethodsThe questionnaire survey was made in the eight-year program students.ResultsApplication of PBL could achieve good feedback.It helped to enhance the self-directed learning,expressing ability,accessing resource skill,and team spirit.ConclusionAlthough there are some problems in the practice of PBL,PBL is a good teaching method in eight-year program education.

Emotional labor is an important constituent of teaching affairs.Research on emotional labor suggests that there are both positive and negative effects for employees.This article aims to reduce negative influence of emotional labor and comes up with some countermeasures for maintaining the mental health of teachers.

Objective To establish the method of measuring quercetin content in semen cuscutae(SC) and to explore its in- vivo pharmacokinetics features.Methods The rapid and sensitive HPLC- UV method was adopted with carbamazepine acting as internal standard. After the extract of SC was given, serum samples of rats were collected and measured on C18 reverse- phase chromatographic column after liquid- liquid extract. Results The linear range of calibration curve were 0.05～ 9? g/mL (r=0.9998). The method showed good precision and recoveries for serum with 86.65～ 99.07% , and extracting recoveries 79.91～ 84.56% .The limit of detection(LOD) as 0.05? g/mL. Conclusion The pharmacokinetic process of quercetin in vivo manifestated an opening two- compartment model with t1/2(Ab)=0.13h, t1/2(? )=0.19h, t1/2(? ) =1.22h, tmax=0.333h. The results may provide evidence of safety and effectiveness for clinical use of SC.

Objective To investigate the application and effect of aerobic exercise of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD).Methods Ninety-four hospitalized patients with COPD from June 2011 to June 2012 were enrolled.The clinical curative effect and safety of aerobic exercise of pulmonary rehabilitation in patients with COPD were observed and compared.Results After 3 months treatment,first second forced expiratory volume (FEV1) and forced vital capacity (FVC) were increased compared with those before treatment [(3.25 ± 0.49) L vs.(2.59 ± 0.55) L,(1.95 ± 0.41) L vs.(1.44 ± 0.48) L],and there were significant differences (P ＜ 0.05).There was no significant difference in FEV1/FVC before and after treatment (P ＞ 0.05).After 3 months treatment,arterial partial pressure of oxygen and arterial oxygen saturation were increased compared with those before treatment [(87.61 ± 8.56) mm Hg(1 mm Hg =0.133 kPa) vs.(63.88 ± 8.79) mm Hg,0.9648 ±0.0449 vs.0.7632 ± 0.0477],partial pressure of arterial carbon dioxide was decreased compared with that before treatment [(30.57 ± 9.47) mm Hg vs.(49.23 ± 9.54) mm Hg],and there were significant differences (P ＜ 0.05).There was no signifi.cant difference in blood pressure and heart rate before and after treatment (P＞ 0.05).No obvious adverse reactions were observed.Conclusions The aerobic exercise of pulmonary rehabilitation can improve significantly lung function.It is safe and rehable,and has less adverse reaction in patients with COPD.It is worthy of promotion and use.

Objective To evaluate the clinical effect of retrievable esophageal covered metal internal stent in treating patients with achalasia.Methods Under DSA guidance,peroral"Z-type"double horn covered metal internal stent implantation was performed in 16 patients with achalasia.Esophagography was carried out about 28 days after the procedure and the stent was retrieved.Results Of 16 cases,the stent fell off into the stomach two weeks after the operation in one.And the stent was successfully replaced after it was taken out.The placed stent was successfully retrieved in all cases 28 days after the treatment.No serious complications occurred.All the patients were followed up for 3 months to 3 years.During the follow-up period restenosis of the esophagus developed in two cases(at one and 1.5 years respectively),and the restenosis degree was relived after balloon dilation.Clinically,no esophageal symptoms,such as dysphagia,occurred in all patients.Conclusion As a simple and safe technique,the retrievable esophageal covered metal internal stent implantation is very effective with fewer complications for the treatment of achalasia.Moreover,the technique carries lower restenosis occurrence.

OBJECTIVE To evaluate the value of central compartment neck dissection for cN0 papillary thyroid carcinoma.METHODS The clinical data of 46 cases with cN0 papillary thyroid carcinoma in our hospital from Jan.1999 to June 2004 were retrospectively studied.The level Ⅵ lymph nodes were removed during the operation.RESULTS In 46 cN0 cases,there were 11 cases(23.9 %) pathologically proved lymph nodes metastasis after operation.Four patients developed neck recurrence and underwent neck dissection.CONCLUSION It is necessary to probe the level Ⅵ lymph nodes during the operation for cN0 papillary thyroid carcinoma patients.

Objective To investigate the expression and antibacterial function of Neutrophil extracellular traps (NETs) in systemic lupus erythematosus (SLE) patients.Methods Thirty stable SLE patients and thirty normal controls (NC) were recruited to this study.The acitivity of SLE was assessed by SLE Disease Activity Index (SLEDAI).Density gradient centrifugation was uesd to isolate neutrophilic granulocytes.Picogreen assay was used to quantify NETs formation.Colony counting method was used to compare the antibacterial rate of NETs between two groups.Variation of quantity and activities of neutrophil elastase (NE) and myeloperoxidase (MPO) on induced NETs was tested by enzyme linked immunosorbent assay (ELISA).Results There was no significant difference in the number of NETs between SLE and NC.Compared to the control group,more NETs were induced from neutrophils in SLE,the antibacterial rate of induced NETs was significantly lower,with the activities of antibacterial protein MPO decreased.Conclusions Stable SLE patients are more easily to induce NETs,and the antibacterial function of induced NETs are truly defective,may be related to the decreased activity of the antibacterial protein MPO.

Objective To assess the feasibility of double phase subtraction angiography with second generation (128-slice )dual-source CT in low dose Flash spiral scan mode for the evaluation of cerebral vessel,compared with dual-energy subtraction angiogra-phy.Methods 60 patients underwent double phrase CT angiography were divided into group A (n = 30,with Flash spiral scan mode),group B(n=30,with dual-energy scan mode).The signal-to-noise ratio(SNR),the contrast-to-noise ratio(CNR)and the av-erage radiation of double phrase subtraction images were measured in two groups,respectively.The double phase subtraction images quality were graded by 2 independent readers on a 5-point scale(5=excellent)in double-blind,according to various degrees of the re-sidual bones,the vessel displayed and luminal integrity,respectively.Differences between two groups were analyzed by Mann-whit-ney test and t test.Results The double phrase image SNR showed no difference to both two groups(P >0.05).The image CNR of arterial and venous phase in group A were higher than that of group B(40.89±8.89 and 40.27 ±9.90 in group A vs 35.28 ±8.43 and 34.89±8.66 in group B;P <0.05)respectively.There were no singnificant difference in the bone removal image scores of doub-le phase and in the vessel image scores of venous phase to both two groups respectively(P >0.05).The vessel image scores of arterial phase were higher in group A than that of group B(4.93±0.25 vs 3.87±0.97;P <0.05).Some internal carotid in the base of skull has not good luminal integrity in group B.The mean dose length product (DLP)in group A was lower than that of group B,with a 39 percent reduction[(226±5.69 )mGy/cm vs (368 ± 21.35 )mGy/cm,P < 0.05 ].Conclusion With the roughly similar image quality to dual-energy double phase subtraction angiography,the cerebral vessels can be assessed using dual-source CT subtraction angiography in Flash spiral scan mode and a lower radiation dose.