Objective To explore the scanning techniques of piriformis and different ultrasonographic characteristics of normal and abnormal piriformis.Methods A total of 40 cases diagnosed with unilateral piriformis syndrome underwent ultrasonic examination.Then ultrasonic scanning techniques of piriformis were summarized.Contours,thickness and smoothness of epimysium and ultrasonic echo of internal muscle texture of piriformis were compared between the normal and abnormal piriformis.The study was approved by the Third Affiliated Hospital Ethics Committee of Zhejiang Chinese Medical University (Approval no.ZSLL-JS-2016-18).Results Interruption of ultrasonic echo of ilium could be considered as ultrasonographic signs for locating piriformis quickly and accurately.Abnormal piriformis in suffering side of patients with piriformis syndrome showed obscure contours and being thicker than the other side [x2 =9.899,P =0.002;(25.81 ± 0.30)mm vs (22.29 ± 0.27)mm,t =13.604,P =0.000].Moreover,there were significant differences in comparing smoothness of epimysium and ultrasonic echo of internal muscle texture of piriformis between the two sides(x2 =23.226,P =0.000;x2 =54.848,P =0.000).Conclusions Interruption of ultrasonic echo of ilium may be an important sign for locating piriformis.Ultrasound can display piriformis clearly and distinguish ultrasonographic images of normal piriformis accurately from abnormal piriformis,which can be taken as an basis imaging for clinical diagnosis of piriformis syndrome.

Objective To investigate the protective effects of vascular endothelial growth factor-165 (VEGF165) transfected the endothelial progenitor cells (EPCs) mediated by lentivirus on acute lung injury (ALI) in rats. Methods The mononuclear cells from the male Sprague-Dawley (SD) rats were isolated and cultured to get the EPCs for study. The lentivirus vector carrying the human VEGF165 gene was constructed. According to the random number table method, 90 male SD rats were divided into ALI model group, phosphate buffer solution (PBS) group, EPCs treatment group, none transfected EPCs treatment group and VEGF165 transfected EPCs treatment group, and the rats in each group were subdivided into 4, 12 and 48 hours subgroups, with 6 rats in each subgroup. The rat model of ALI was reproduced by intravenous injection of oleic acid (0.15 μL/g). Then each treatment group was given PBS, EPCs, none transfected EPCs and VEGF165 transfected EPCs respectively with the same volume of 0.2 mL. For the groups with cells, about 1×106cells were contained. Abdominal aortic blood and lung tissue were harvested at 4, 12 and 48 hours. Arterial blood gas analysis was performed. The lung wet/dry weight ratio (W/D) was calculated. The expressions of induced nitric oxide synthase (iNOS), endothelin-1 (ET-1) and VEGF165 were determined by enzyme-linked immunosorbent assay (ELISA). After dyed with hematoxylin-eosin (HE), the lung tissue pathology was observed and the lung injury score was performed. Results Compared with the ALI model group, the arterial partial pressure of oxygen (PaO2) in EPCs, none transfected EPCs and VEGF165 transfected EPCs treatment groups was significantly increased from 4 hours, and lung W/D, expressions of iNOS and ET-1 were significantly decreased, and VEGF165 expression was significantly increased. Compared with the EPCs treatment group, the increase in PaO2, the decrease in lung W/D and expressions of iNOS and ET-1, and the increase in VEGF165 expression in VEGF165 transfected EPCs treatment group were more significant [4 hours: PaO2(mmHg, 1 mmHg = 0.133 kPa) was 82.84±10.69 vs. 72.34±9.36, lung W/D ratio was 4.83±0.23 vs. 5.55±0.37, iNOS (ng/mg) was 8.77±1.10 vs. 14.84±1.34, ET-1 (ng/mg) was 103.41±5.66 vs. 153.08±5.12, VEGF165 (ng/mg) was 130.56±12.16 vs. 83.03±5.95; 12 hours: PaO2(mmHg) was 91.67±6.81 vs. 78.5±8.81, lung W/D ratio was 4.44±0.35 vs. 5.32±0.25, iNOS (ng/mg) was 7.23±0.24 vs. 14.04±1.18, ET-1 (ng/mg) was 91.98±3.52 vs. 125.99±7.55, VEGF165 (ng/mg) was 164.49±5.71 vs. 96.61±6.12]; individual parameters reached valley value or peak value at 48 hours [lung W/D ratio was 4.26±0.30 vs. 4.89±0.15, iNOS (ng/mg) was 5.79±0.85 vs. 12.72±1.10, ET-1 (ng/mg) was 74.53±7.10 vs. 108.33±5.84, VEGF165 (ng/mg) was 237.43±10.79 vs. 134.24±11.99, all P < 0.05]. Over time, lung tissue injury in each group was gradually increased, and the lung injury score was gradually increased. The lung injury score at 48 hours in the EPCs, none transfected EPCs and VEGF165 transfected EPCs treatment groups were lower than that in the ALI model group. Compared with the EPCs treatment group, the VEGF165 transfected EPCs treatment group had a lower score at 48 hours (8.50±1.05 vs. 10.50±1.05, P < 0.05). Conclusion The transplantation of EPCs which were transfected with VEGF165 mediated by lentivirus could obviously improve the oxygen pressure, reduce the lung water seepage, decrease the iNOS and ET-1 expressions in lung tissue, and had obvious protective effects on ALI.

Objective To investigate the effect of preoperative preplacement of nasobiliary drainage in radiofrequency ablation of small hepatocellular carcinoma at hepatic portal. Methods 7 patients with small hepatocellular carcinoma who were admitted to our hospital from June 2014 to June 2017 were selected. All patients were the cases who were prone to injure the bile duct at hepatic portal upon the radiofrequency electrode needle entering liver cancer in the small hepatocellular carcinoma at hepatic portal. The nasal bile duct was pre-placed preoperatively, and infusion of water into nasobiliary bile duct was conducted to expand the bile duct for intraoperative identification and avoiding false puncture. In some cases, after intraoperative bile duct injury, postoperative nasobiliary drainage was given to avoid obstructive jaundice or the occurrence of bile tumor at hepatic portal. Results The treatment effective rate in the patients was 100％ (7/7). Blood biochemistry, routine blood test, liver function were re-examined after surgery. Liver CT or MRI was reexamined 30 to 60 d after surgery. After the preplacement of nasal biliary, there was one case of pancreatitis, with the incidence rate of complications of 14. 3％. The long-term treatment effect was favorable, without tumor recur-rence. Conclusion For small hepatocellular carcinoma at hepatic portal, preoperative preplacment of nasobiliary drainage is used, and the direction of the bile duct during radiofrequency ablation can be clearly observed, so as to effectively avoid the bile duct injury.

Objective: To explore the clinical application of three-dimensional face virtual plastic system. Methods: 80 patients (28 males and 52 females, aged 18-40 years) who underwent facial plastic surgery in Xiangya Hospital were sampled with two-dimensional human color images and three-dimensional human point cloud data continuously. Face detection was performed on the collected data, and super-resolution fusion was performed on the detected three-dimensional human point clouds. A three-dimensional face model was built using the fused three-dimensional face point cloud data, and the texture mapping technology was used to realize the mapping from two-dimensional color image to three-dimensional face model. Finally, patients and doctors perform virtual surgery on the three-dimensional face model interactively to obtain satisfactory target three-dimensional face model. By comparing the changes of three-dimensional face model before and after virtual surgery, the data to be adjusted in the facial plastic surgery were obtained, and 80 patients received facial plastic surgery according to the data. The three-dimensional face model of patients was reconstructed one year after operation, and then compared with the model of virtual surgery to evaluate the effect of plastic surgery. Results: 80 patients underwent plastic surgery with the above method, including 6 cases of medial canthus, 9 cases of lateral canthus, 20 cases of rhinoplasty, 25 cases of lip thinning, and 20 cases of facial fat grafting. One year after operation, 80 patients were satisfied with the result of plastic surgery. Conclusions The three-dimensional virtual facial plastic system makes the process of plastic design individualized, quantified and digitized. It enables patients to have a better understanding of prognosis in advance, facilitating the communication between doctors and patients, and reducing unnecessary medical disputes.

Objective: To describe the dermoscopic features of extramammary Paget′s disease (EMPD) and chronic eczema of the vulva, and to explore the value of dermoscopy in the diagnosis and differential diagnosis of the above diseases. Methods: Dermoscopic images were collected from 20 patients with histopathologically confirmed vulvar EMPD and 16 patients with clinically confirmed chronic eczema of the vulva in Hospital for Skin Diseases, Chinese Academy of Medical Sciences and Pekin Union Medical College from January 2017 to April 2018, and retrospectively analyzed. Fisher′s exact test was used to compare the prevalence of dermoscopic features between the two groups. Results: As dermoscopy showed, the milky red background was observed in 19 EMPD patients and in only 1 patient with chronic eczema, and there was a significant difference in the prevalence of milky red background between the two groups (P < 0.001) . White scales were the most common desquamation, and were observed in 9 EMPD patients and 13 patients with chronic eczema (P = 0.128) . Blood vessels were uniformly distributed in EMPD patients, including dotted-globular vessels in 19 and linear vessels in 14, while blood vessels were distributed in a patchy or clustered pattern in the patients with chronic eczema, including dotted-globular vessels in 16 and linear vessels in 7. There was a significant difference in the prevalence of different distribution patterns of blood vessels between the two groups (P < 0.001) . Bright white streaks, bright white structureless area and reticular structure were observed in 19, 20 and 19 EMPD patients respectively, and in 1, 1 and 1 patient with chronic eczema respectively, and there were significant differences in the prevalence of the above 3 structures between the two diseases (all P < 0.001) . Conclusion Vulvar EMPD and chronic eczema both show characteristic dermoscopic features, and dermoscopy is of great value to the diagnosis and differential diagnosis of EMPD.