Carcinoma of gallbladder is the most frequently encountered malignancy of the biliary system. Early diagnosis is very difficult and the tumour resection rate is low,and the prognosis of carcinoma of gallbladder is very poor. With the increasingly widespread acceptance of laparoscopic cholecystectomy (LC),the number of cases of unsuspected gallbladder carcinoma (UGC) has increased. However,management of UGC is a difficult issue in the absence of established guidelines. High age and history of stones are the risk factors for gallbladder carcinoma and they are related to UGC. Surgical handling and pneumoperitoneum play an important role in the metastasis. The surgical approach used for cholecystectomy would not seem to influence the outcome in patients with UGC. The tumour stage is the most important prognostic factor. To understand UGC better, we review its clinical characteristics,investigation,prognosis and especially the recent advances in the diagnosis and treatment of this disease.

The study of subjects with different serum levels (mmol/L) of glucose, including NC (FPG6.1 mmol/L,

ObjectiveTo assess the diagnostic performance of contrast-enhanced ultrasound(CEUS)in characterization of adnexal masses in comparison with baseline ultrasound.MethodsOne hundred and thirty-seven masses were examined by CEUS and baseline ultrasound.Two independent investigators reviewed the images before and after contrast agent administration.The diagnostic performances were evaluated using receiver operating characteristic (ROC) analysis and the interobserver agreement was analyzed.ResultsAfter review of CEUS,ROC analysis revealed significant improvement in differentiating between malignant and benign pelvic masses that the areas under the ROC curve were 0.731 and 0.738 at baseline ultrasound versus 0.891 and 0.903 at CEUS ( P ＜0.01 ).The accuracy for both investigators also improved significantly after reviewing CEUS.A better interobserver agreement was achieved after reviewing of CEUS (g =0.681 at baseline ultrasound versus κ =0.893 at CEUS) and a better result of specific diagnosis was obtained (73.2％ and 74.2％ at baseline ultrasound versus 90.7％ and 91.2％ at CEUS)(all P ＜ 0.01 ).Conclusions Real-time CEUS improves the diagnostic performance in adnexal masses for discrimination between malignancy and benignity and improves the capability in specific diagnosis compared with baseline ultrasound.

Objective To assess the diagnostic performance of contrast-enhanced ultrasound in characterization of pelvic masses.Methods Contrast-enhanced ultrasound was performed on 137 patients with pelvic masses.The results were compared to pathological diagnostic criteria.The diagnostic performance was evaluated by using diagnostic test.Results Sensitivity,specificity,positive predictive value,negative predictive value,accuracy and area under ROC curve in diagnosing complex pelvic masses by using contrast-enhanced ultrasound were as follows:85.3％ (29/34),93.2％ (96/103),80.6％ (29/36),95.0％ ( 99/101 ),91.2％ ( 125/137 ),0.892,respectively.Conclusions Contrast-enhanced ultrasound provides a simple and curate method for characterization of pelvic masses.

Objective To explore the value of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of subserous myoma (SM) and ovarian fibroma.Methods CEUS was performed on 58 patients with SM and 26 patients with ovarian fibroma.The enhancement pattern was observed.The diagnostic performance was evaluated by using diagnostic test.Results SM exhibited homogeneous isoenhancement synchronously with the myometrium in early phase.In the late phase,the pseudocapsule remained hyper-enhancement with obvious membraniform sign.Some myomas showed the feeding artery from uterus.Ovarian fibroma demonstrated hyper-enhancement at the periphery portion and hypoenhancement inside.Conclusions The SM and ovarian myomas showed different enhancement patterns,which may provide us some exact information in the differential diagnosis between the two diseases.

Objective To evaluate the feasibility and accuracy of the transvaginal real-time three-dimensional hysterosalpingo-contrast sonography(RT 3D-HyCoSy) with SonoVue in the assessment of tubal patency.Methods Tubal patency was investigated by RT 3D-HyCoSy in 96 unselected infertile patients (a total of 191 tubes).The image quality of RT 3D-HyCoSy was evaluated.Laparoscopy was performed in 35 cases (a total of 70 tubes) of them.The efficacy of the procedure was compared with laparoscopy.Results The mean score of image quality of RT 3D-HyCoSy in ninety-six cases was 2.94 ± 0.26.The accordance between RT 3D-HyCoSy and laparoscopy was good,with the Kappa value was 0.802.Sensitivity,specificity,positive predictive value,negative predictive value and accuracy in diagnosing tubal patency by using RT 3D-HyCoSywas 87.5％ (14/16),94.4％ (51/54),82.3％ (14/17),96.2％ (51/53),92.9％ (65/70),respectively.Conclusions Transvaginal RT 3D-HyCoSy is a good imaging technique which can display the morphological character of fallopian tube and assess the patency.

Objective:To evaluate the validity and reliability of the Chinese version of the Eating Disorder Examination Questionnaire 6.0 (EDE-Q 6.0) in female patients with eating disorders.Methods:A total of 239 patients with eating disorder and 142 healthy controls who were recruited consented to participate in the study and completed Chinese EDE-Q 6.0.Confirmatory factor analysis was used in patients to compare the original 4-factor model,1-factor model and 3-factor model.The criterion validity was tested with the Eating Disorder Inventory (EDI).Mann-Whitney U analysis was used to compare the differences of EDE-Q 6.0 scores on the two samples to test the empirical validity,and ROC analysis was used to determine the cut-off value.The internal consistency of the scale was tested in two samples.Among all participants,89 patients and 31 healthy controls were retested 1 month later.Results:The original 4-factor model fit better than the other two.The EDE-Q 6.0 total score and the EDI total score had a high consistency in the total sample,patients and controls,respectively (ICC =0.88,0.87,0.73).Patients had higher scores on the EDE-Q 6.0 than controls (Ps ＜0.01).The mean area under the curve (AUC) of EDE-Q 6.0 was 0.91,the optimal cut-off point of EDE-Q 6.0 was total score ≥ 1.27,sensitivity and specificity were 79.4％ and 88.2％ respectively.The Cronbach α coefficients were 0.95,0.91,and 0.88 for the total sample,patients and controls respectively.The test-retest reliabilities were 0.73 for the total scale,0.58,0.68,0.69 and 0.71 for the 4 factors.Conclusion:The Chinese version of the Eating Disorder Examination Questionnaire 6.0 have good psychometric properties and diagnosis accuracy,and it could be used to assess the severity of clinical symptoms.

Objective To compare the value of acoustic structure quantification(ASQ) and shear wave elastography(SWE) in the evaluation of diagnostic accuracy of liver fibrosis.Methods One hundred and thirty-five patients with chronic hepatic diseases enrolled in our study were underwent ASQ,SWE and liver biopsy.Correlation between Total Mode,BR ratio,the elastic modulus and pathological stages of liver fibrosis were analyzed by Spearman's rank test.ROC curves were set up by evaluating the degree of hepatic fibrosis through Total Mode,BR ratio,the elastic modulus.Results The significant positive correlation were observed between Total Mode,BR ratio,the elastic modulus and pathological stages of liver fibrosis(r =0.46,P =0.000; r =0.49,P =0.000; r =0.68,P =0.000,respectively).Total Mode,BR ratio,and the elastic modulus,of each pathological stages,had statistically significant differences (F =6.05,P =0.000 ; F =5.17,P =0.000; F =48.82,P =0.000,respectively).The areas under the ROC curve (AUC) set up by evaluating the pathological stages of fibrosis (S≥ 1,S≥2,S≥3 and S =4) through the elastic modulus were larger than that of Total Mode and BR ratio(all P ＜0.05).But the AUC for the diagnosis of fibrosis of Total Mode and BR ratio showed no statistically significant differences(all P ＞0.05).Conclusions SWE was more accurate than ASQ parameters (Total Mode,BR ratio) in grading hepatic fibrosis.ASQ parameters (Total Mode,BR ratio) were observed well-correlated with the pathological staging of hepatic fibrosis.

Objective To investigate the application value of transperineal ultrasound in female urethras and pathological change of circum-urethras.Methods 403 female patients were examined by transperineal ultrasound in condition of resting and maximum Valsalva,female urethras and pathological changes of circum-urethras were observed and ultrasonic manifestation were concluded.Results By transperineal ultrasound the images of normal urethras and pathological change of circum-urethras were clearly discernible.403 female patients were examined,380 normal.18 urethral calcification,there was hyperecho stripe in urethras.2 urethral cyst,there was round anechoic area in circum-urethras and no fistula between round anechoic area with urethras.2 urethral diverticulum,there was round anechoic area in circumurethras and a fistula between round anechoic area with urethras.1 urethrovaginal fistula,there was irregular hypoechoic area between urethras with vagina,the irregular hypoechoic area both communicate with urethras and vagina.Conclusions Transperinealr ultrasound can be used for examination urethras and pathological change of circum-urethras in female patients and may provide more reliable information for clinical diagnosis.

ObjectiveTo develop the interacting learning mode in simulative situation on sex and health courses for college students and evaluate the effect of it.MethodsThe core curriculum for general education of sex and health was open to all the students in Shanghai Jiao Tong University from Feb.2010 to Jun.2011.The courses imported simulative-situation-learning method.At the end of the semester,the feedbaick and the suggestion of the students were collected and sorted.ResultsAll groups from the course involved the simulative situation seriously,which included homosexuality of college students,undesired pregnancy and contraception knowledge,etc.According to the feedback of the courses,most of the students acceptted this kind of teaching method.ConclusionInteracting learning in simulative situation can obviously increase the interest and enthusiasm of students.Meanwhile,the new courses not only improve students' understanding of knowledge,but also improve their communication skills and team work ability.