Objective To evaluate the value of metal spring ring for localization of breast lesions. Methods Thirteen cases of nonpalpable breast benign lesion and 41 cases of breast cancer that had been treated by neoadjuvant chemotherapy were enrolled in this study. The lesion was localized with the margin being marked under the guidance of ultrasonography. Metal spring rings with proper length was used according to the maximum diameter of the lesion; and then via a 18G puncture needle, the metal spring ring was place exactly to the two ends of the biggest cross-section of the lesion by using a guide wire. Afterwards, the lesions were resected with the spring ring. The 41 patients with breast cancer received 2-to 3-week chemotherapy after the operation. Results For the 13 cases of benign breast lesion, the mass was resected accurately and completely with the spring rings. In the 41 cases of breast cancer, no residual tumor cells were found in the tissues around the margin of resection. During the postoperative chemotherapy, ultrasonography showed that the mass was reduced in 39 of the cases, among which 9 had no clear margin of the tumor before the operation shown by ultrasonography. Off the 9 cases, postoperative pathological examination found no tumor cells in the successive sections. Conclusions Localization of breast lesions under the guidance of ultrasonography is a new method for diagnosis and treatment of nonpalpable breast lesions. It is valuable for follow-up by ultrasonography, evaluation of chemotherapy, and postoperative biopsy, especially for the breast cancer patients who have received preoperative chemotherapy.

Objective To assess the clinical value of ultrasound-guided popliteal vein puncture in the treatment of lower extremity deep venous thrombosis.Method We performed ultrasound-guided catheterization through popliteal vein in 71 patients with lower extremity deep venous thrombosis who were supposed to receive catheter-directed thrombolysis.Results Catheter sheathes were successfully inserted in 69 patients.No severe complication was observed.and a good curative effect after the treatmeut of thrombolysis and anticoagulation was found.Insertions of guide-wires failed in 2 patients because of organizatioo of the thrombus.Conclusion Ultrasound-guided popliteal vein puncture is safe and easy to operate,and is worth popularizing.

BACKGROUND: Electromagnetic pulse (EMP) irradiation can cause the decline of learning and memory abilities of rats, and lead to the intracellular calcium overloading of hippocampal neurons in vitro, and then result in necrosis and apoptosis. Physical shield can alleviate the damage of electromagnetic irradiation on experimental animals, but studies of the medicine prevention and protection on cell models are still in lack.OBJECTIVE: To observe the possibility of medicine in preventing and protecting the EMP-induced injury of hippocampal neurons in vitro.DESIGN: A randomized controlled animal experiment.SETTING: Division of Basic Medical Sciences, Chengde Medical College.MATERIALS: The experiments were carried out in the Academy of Military Medical Sciences and Chengde Medical College from January 2004 to January 2005. Several neonatal Wistar rats were used.METHODS: The neonatal Wistar rats were killed by cutting heads to remove brain, and the hippocampal neurons were primarily cultured and identified. After pretreatment with MK801 [N-methyl-D-aspartate (NMDA)receptor antagonist] and nifedipine (L-type Ca2+ channel blocking agent),the primarily cultured hippocampal neurons were irradiated with EMP. The condition of our experiment was 6×l04 Y/m, pulse rise time was 20 ns,pulse width was 30 ms, and frequency was 2.5 pulse per minute for 2 minutes. The neurons cultured in special petri dish, which could be observed under LSCM high amplified resolution, were divided into EMP irradiation group, MK801 20 μmol/L group, MK801 20 μmol/L+ nifedipine 1 μmol/L group. The cellular activities were detected with methyl-thiazol-tetrazolium (MTT) colorimetry; The rate of apoptosis was detected with FASC method;The intracellular free Calcium concentration ([Ca2+]i) was determined by loading with Fluo-3-AM Ca2+ fluorescent probe (Molecular Probes Company) on the laser scanning confocal microscope.MAIN OUTCOME MEASURES: The intracellular calcium overloading,cellular activity and rate of apoptosis were compared.RESULTS: ① The [Ca2+]i fluorescent intensity in the EMP irradiation group immediately after irradiation was significantly higher than that in the normal control group (107.34±26.14, 54.93±16.08, P＜0.05); As compared with the EMP irradiation group, the [Ca2+]i fluorescent intensity was decreased in the MK801 20 μmol/L group (81.29±19.96, P ＜ 0.05), and further decreased in the MK801 20 μmol/L+ 1 μmol/L nifedipine group (69.82±25.54, P＜0.05), but both were higher than that in the normal control group (P＜0.05). ②The A values that reflected the activity of cell proliferation MK801 20μmol/L group and MK801 20 μmol/L+1 μmol/L nifedipine group (0.25±0.06, 0.27±0.07) were obviously higher than that in the EMP irradiation group (0.17±0.08, P ＜ 0.05), but still lower than that in the normal control group (0.33±0.08, P ＜ 0.05). ③ The rate of apoptosis in the EMP irradiation group immediately after irradiation was significantly higher than that in the normal control group [(68.63±9.04)%, (20.14±4.34)%,P＜0.01]; As compared with the EMP irradiation group, the rate of apoptosis was decreased in the MK801 20 μmol/L group (62.12±11.08)%, and further decreased in the MK801 20 μmol/L± 1 μmol/L nifedipine group [(53.69±13.60)%, P ＜ 0.05], but both were higher than that in the normal control group (P ＜ 0.01).CONCLUSION: Pretreatment with MK801 and nifedipine can partly block EMP induced damage in hippocampal neurons in vitro. Intracellular Ca2+ Overloading may play an important role in the injury of EMP on hippocampal neurons.

Objective To investigate the safety and efficiency of large-dose alcohol sclerotherapy in treating simple hepatic cyst. Methods Patients with hepatic cyst were divided into two groups. One group with 49 patients was treated with small-dose (<80 ml) absolute alcohol instillation. The other one with 32 patients was treated with large-dose (≥80 ml) absolute alcohol instillation. Blood alcohol concentration (BAC) was recorded right after and 30 rain, 1 h,2 h,3 h after the treatment. Diameter of cyst as a parameter of efficiency was recorded and compared between two groups during 1 year follow-up visit. Results Large-dose group was significantly more efficient in treating hepatic cyst than small-dose group. All BAC records were within the safe range and below the legal limit after drinking. BAC reached its peak 30 minutes after the treatment began and then decreased gradually. A significant correlation was found between BAC and the alcohol dosage. Conclusions Ultrasound-guided sclerotherapy with repeated large-dose absolute alcohol instillation is a safe and efficient treatment for simple hepatic cyst from the perspective of BAC.

Objective To investigate the effect of acupuncture plus astragalus polysaccharide on the expression of Bcl-2 protein in pancreatic islet b cells in db/db mice. Method C57BL/Ksj-db/db mice as an animal model of spontaneous type 2 diabetes were selected for this experiment. Five-week-old db/db mice were randomized into model, acupuncture, medication and acupuncture+medication groups. Meanwhile, db/m mice were selected as a normal group. The acupuncture group received acupuncture at points Housanli (equivalent to Zusanli, ST36), Neiting(ST44) and Yishu(Extra) and the medication group, an oral gavage of astragalus polysaccharide (1400 mg/kg). Both groups were treated once daily, for 12 consecutive weeks. After the end of experiment, blood glucose, insulin and resistin were measured, and the expression of Bcl-2 protein in islet b cells was determined by immunohistochemical method. Result Blood glucose, insulin and resistin levels were significantly lower in the acupuncture+medication, acupuncture and medication groups than in the model group. They were significantly lower in the acupuncture+medication group than in the acupuncture and medication groups and significantly lower in the acupuncture group than in the medication group. The expression of Bcl-2 protein in islet b cells was higher in the medication, acupuncture and acupuncture+medication groups than in the model group; there was a statistically significant difference (P<0.01). The expression of Bcl-2 protein was higher in the acupuncture+medication groups than in the medication group (P<0.01) and it was basically the same in the medication group as in the acupuncture group; there was no statistically significant difference (P>0.05). Conclusion Acupuncture plus astragalus polysaccharide can significantly reduce blood glucose and serum insulin and resistin levels and increase the expression of Bcl-2 protein in islet b cells to effectively inhibit apoptosis in islet b cells in db/db mice. Its effect is better than that of acupuncture alone or medication.

ObjectiveOne hunred and twenty-four To probe into application value of ultrasound guided Catheterization in internal jugular vein. MethodsOne hundrel and twenty-four guided by ultrasound puncture holder, single-channel or three-channel catheter was embedded into jugular vein. ResultsThe catheter was inserted successfully by only one procedure in all the 124 patients. There was no complication. ConclusionsThe catheterization becomes safer, convenient and quickly with ultrasound puncture holder guidance, decreasing failure rate and complication of the procedure.

Objective To realize the status in the implementation of three industry standards of central sterile sup-ply department (CSSD),and provide a scientific basis for carrying out of the standards. Methods According to three standards,investigation forms were designed by specialists,written survey on 365 hospitals in 9 provinces and field investigation on 1 5 hospitals in 3 provinces were performed,the implementation of three standards were investi-gated.Results Of 365 hospitals,the number of provincial and ministerial level,municipal level,and county level hospitals were 90,87 and 188 respectively. More than 94% of hospitals established CSSD management system and regulations,>90% of hospitals met the requirements of CSSD layout;All hospitals were equipped with pressure steam sterilizer,all levels of hospitals basically equipped with the necessary equipments and facilities;CSSD respon-sible officers of 94.52% (345/365)of hospitals participated in training on standards;69.61% (252/362)of hospi-tals were using or developing CSSD information systems;>92% of the CSSD responsible officers considered that three standards played an important role in facilitating centralized management,and improving the quality of clean-ing,disinfection and sterilization.Conclusion Hospitals need to strengthen the management and training on stand-ards of CSSD,management of loaner instruments and development of information system need to be standardized.

Objective To evaluate the value of contrast-enhanced uhrasound(CEUS)for liver fibrosis.Methods Ninty-two chronic hepatitis B patients with histology diagnosis and fifteen health control were detected by CEUS,dynamic images and the time-intensity curve were analyed.Results Hepatic veinartery transit(HV-ATT)became shorter in the early hepatic cirrhosis patients [(7.5±2.1)s]compared to the control[(11.8±2.7)s].However,there was no difference between the fibrosis patients [(13.0±2.2)s]and the control.Furthermore,HV-ATT of the fibrosis patients with S1 to S3 stage were(11.7±2.7)s(S1),(11.8±3.0)S(S2),(11.8±2.3)s(S3)without significant difference.Conclusions CEUS is valuable in diagnosing earlier hepatic cirrhosis,but not fibrosis.

Etelcalcetide (ParsabivTM) is a second generation calcimimetic agent newly developed by Amgen,mainly used for the treatment of secondary hyperparathyroidism.Etetcalcetide not only decreases calcium concentration by directly binding with the calcium sensing receptor,but also reduces the parathyroid hormone level.The European Union has approved for chronic kidney disease patients with secondary hyperparathyroidism in dialysis with Etelcalcetide injection.This paper summarized the pharmacological effects,pharmacokinetics,clinical trials,and adverse reaction of Etelcalcetide.

Objective To investigate the effect of MS-275, an histone deacetylase ( HDAC ) inhibitor, on acute liver failure ( ALF ) induced by D-galactosamine and lipopolysaccharide in mice. Methods Thirty specific pathogen free (SPF) C57BL/6 male mice were randomly and equally divided into control, ALF model and MS-275 groups. ALF model was induced by D-galactosamine ( D-Gal ) and lipopolysaccharide (LPS), and the mice in MS-275 group received MS-275 (1 mg/kg) at 2 h before the induction of ALF.Serum and liver samples of mice were obtained at 24 h after ALF induction.The serum levels of ALT, AST, TBil and tumor necrosis factor-alpha ( TNF-α) , interferon γ( IFNγ) , interleukin ( IL )-1β, high mobility group box 1 ( HMGB1 ) were tested by biochemical methods or ELISA kit, respectively.The expression of HDAC1, HDAC3, acetylation of histone H3, H4, P65, acetylation and phosphorylation of P65 in liver were detected by Western blotting.The changes of histology in liver was detected by HE staining, and the translocation of P65 in liver was detected by immunohistochemistry. Comparison of variables among the groups was performed using t test.Results MS-275 inhibited the infiltration of inflammatory cells and improved the pathological changes of liver tissue.Compared with ALF group, serum ALT, AST, TBil levels were decreased in MS-275 group ( t =-22.215, -11.914 and-12.160, all P<0.05), but still higher than those in the control group (t=14.852, 11.692 and 8.333, all P<0.05); serum TNF-α, IFNγ, IL-1β, HMGB1 levels were also significantly decreased in MS-275 group (t=-7.926, -3.427, -2.475 and -5.920, all P<0.05), but TNF-αand IFNγwere still higher than those in the control group (t=5.541 and 5.514, all P<0.05).Compared with control group, the expression of class I HDAC in liver tissue was significantly decreased in MS-275 group ( t=-3.676 and-10.576, P<0.05), while the expressions of acetylation of histone H3, H4 and P65 were significantly increased (t=3.976, 5.559 and 4.588, all P<0.05).MS-275 inhibited the translocation of P65 from cytoplasm to the nucleus.Conclusion MS-275 can protect liver from acute failure in mice through enhancing the acetylation levels of non-histones.