ObjectiveTo explore the clinical value of ultrasonography in the detection of median nerve in diabetic peripheral neuropathy (DPN).MethodsMedian nerve was detected in 70 healthy adults (control group) and 43 patients with type 2 diabetes mellitus (diabetes mellitus group) by color Doppler ultrasonography.The type 2 diabetes mellitus patients were divided into two groups according to the duration of the disease:＜ 10 years group (26 cases) and ≥ 10 years group( 17 cases).And they were divided into two groups according to the random plasma glucose (RPG):RPG ＜ 15 mmol/L group(28 cases) and RPG≥ 15mmol/L group ( 15 cases).The nerve cross section area (CSA) was taken at the level of the pisiform.Results The median nerve in diabetes mellitus group had decreased echogenicity and increased color in it.The CSA of the median nerve in diabetes mellitus group was significantly higher than that in control group [ ( 10.3 ± 2.1 )mm2 vs. (8.3:± 1.7) mm2 ] (P ＜ 0.01 ).The C SA of the median nerve in ≥ 10 years group was significantly higher than that in ＜10 years group [ ( 12.3 ± 2.0) mm2 vs.( 10.2 ± 2.6) mm2] (P ＜ 0.01 ).The CSA of the median nerve in RPG ≥ 15 mmol/L group was significantly higher than that in RPG ＜ 15 mmol/L group [ ( 11.7 ± 1.8) mm2 vs.(9.6 ± 2.7 ) mm2 ] (P ＜ 0.01 ).ConclusionColor Doppler ultrasonography examination may reveal morphology of median nerve and is useful for the diagnosis of DPN.

Objective To evaluate the diagnostic values of location and qualitation of tendinitis of rotator cuff. Methods One hundred and sixty-two shoulders with shoulders pain or functional incapacity were performed ultrasonography and the sonograms were classified. Results Ultrasonic findings of these tendinitis were tendinitis of caput longum musculi bicipitis brachii in 39 cases, tendinitis of caput longum musculi bicipitis brachii in 33 cases, supraspinatus tendinitis in 51 cases, calcific supraspinatus tendinitis in 19 cases and bursitis of shoulder in 20 cases,especially. Conclusions Ultrasonography is a useful tool for diagnosis of tendinitis of rotator cuff in location and qualitation.

Objective To summarize the initial outcome of single lung transplantation in the treatment of endstage pulmonary disease.Methods From Jan.2003 to June 2005,11 cases were subjected to single lung transplantation consecutively at our hospital.Of the 11 patients with end-stage pulmonary diseases,7 underwent the right single lung transplantation,and 4 the left procedure.Among them,2 patients received single lung transplantations by the same donor.Results Of the 11 patients,6 cases have been alive for more than 1 year(including 3 cases been alive for more than 2 years).Three cases have been alive for more than 6 months.Lung function examination was done 2 months after lung transplantation.Nine patients showed normal PaO_(2) values(more than 80 mm Hg) with an average improvement of(37.6%),and 8 obtained an average improvement of(165.2%) in FEV_1.One case died of bleeding intra-operatively.One case died of chylothorax at 3rd month post-operatively.The incidence of acute rejection was(1.2) averagely in this group.As to other complications,aspergillosis occurred in 4 cases,severe lung infection in 2 cases,reperfusion-injury-induced pulmonary edema in 1 case at 36th h postoperatively,and upper alimentary canal hemorrhage in 1 case at 7th day.Chronic rejection occurred in 1 case at first year postoperatively.Conclusions Single lung transplantation is effective in treating end-stage pulmonary disease.The incidence of complication was higher after lung transplantation.Effective prevention and management should be emphasized.

Objective To evaluate the feasibility and efficiency of endoluminal catheter-based ultrasonography on diagnosis of upper urinary tract diseases. Methods From January 1997 to December 2006,the clinical data of upper urinary tract of 68 cases who examined by endoluminal uhrasonography with a 10 MHz miniature ultrasound transducer and a 8 F outer catheter were reviewed.There were 30 males and 38 females aged 17-81 years with an average of 58 years.The renal pelvis and its surrounding structures were examined in 48 cases and the ureter and its surrounding structures were examined in 20 cases.The total of 73 sides had experienced by this technique.The accuracy of diagnosis with endoluminal catheter-based ultrasonography was evaluated by the pathology and clinical follow-up. Results The total success rate of the ultrasound probe introduced into ureter was 91%in 68 cases.In the pelvis group it was 96%(46/48)and the ureter group 80%(16/20).In renal pelvis abnomalities,the detectable rate of abnormal by ultrasonography was 89%(41/46).The total detectable rate in ultrasound probe group was significantly higher than that in other equipment groups(P＜0.01).The detectable rate of ultrasonography on ureter disease was 75%(12/16). Conclusion Endoluminal catheter-based ultrasonography is an effective,safe technique for the diagnosis of diseases in the upper urinary tract.

Objective To evaluate the value of high frequency ultrasound in sciatic nerve of rat with diabetic neuropathy.Methods Fifty male Sprague-Dawley rats were divided into 4 groups:Diabetic animals were induced by intravenous injection of streptozotocin after high fat feed for 1 month,after which rats were grouped as 3-month (n =12) and 5-month (n =20) diabetes.Control group were received the streptozotocin vehicle and were classified as 3-month group (n =8) and 5-month group (n =10).Ultrasounic study of cross sectional area (CSA) and pathologic study including number and area of nerve fiber were performed at 3 and 5 months according to the disigned.Results The CSA,number and area of nerve fiber in 5 month diabetes were significantly reduced than 5-month control group (t =5.121,P ＜ 0.05; t =7.113,P ＜0.05; t =6.328,P ＜0.05).The CSA were statistically with the number and area of nerve fiber in 5 month diabetic group (r =0.732,P ＜0.05 ; r =0.715,P ＜0.05).However,the CSA had no significant correlation with the number and area of nerve fiber between 3-month diabetes and control group (P ＞0.05).Conclusions The CSA of sciatic nerve can evaluate the diabetic neuropathy of rat,which might be regarded as a potential index in diagnose of diabetic neuropathy.

Objective To evaluate the morphological changes of sural nerve in patients with type 2 diabetes mellitus by hyperfrequency ultrasound.Methods Fifty-six sural nerves of symptomatic group,64 sural nerves of asymptomatic group,and 60 sural nerves of control group were identified by 22 MHz Ultrasound.The thickness/width (T/W) ratio,cross-sectional areas (CSA) and the maximum thickness of neuronal fascicles (MT) of the sural nerve were calculated in transverse sonograms.Results ①Ultrasound can clearly show these structures of sural nerve such as epineurium,perineurium and nerve bundles and so on.②In symptomatic group,asymptomatic group and control group,T/W ratio and MT were gradually increased,and the differences among the three groups were statistically significant (P＜0.05).Whereas,there were no statistically significant differences in CSA among the three groups (P=0.257).Conclusions22 MHz ultrasound may be a valuable tool in evaluating the diabetic cutaneous nerve neuropathy

Objective To investigate the effectiveness and safety of simultaneous lung volume reduction surgery in the treatment of lung volume mismatch after single lung transplantation. Methods Twenty-four single lung transplantations were performed on 20 male and 4 female patients, with a mean age of 54. 6 ± 12. 2 years (ranging from 28 to 75 years). Indications for transplantation included end-stage chronic obstructive lung disease (COPD) in 14 cases, COPD combined with upper lobe lung destruction in 1 case, COPD combined with pneumoconiosis in 1 case, end-stage interstitial pulmonary fibrosis in 6 cases, lymphangioleiomyomatosis (LAM) in 1 case, and post-transplantation bronchiolitis obliterans syndrom (BOS) in 1 case. Sixteen cases had right-side and 8 cases had left-side lung transplantation. Lung volume reduction surgeries were performed through open thoracotomy. Graft lung volume reduction was carried out through the same incision as transplantation, and native lung volume reduction through a small anterior lateral incision contralaterally. Patients were divided into lung volume reduction group (group Ⅰ) and control group (group Ⅱ). There were 8 cases in group Ⅰ,including 5 graft lung, 2 native lung, and 1 graft and native lung volume reduction surgeries. In group Ⅱ, there were 16 cases that had no further treatment for lung volume mismatch. Differences in various clinical parameters between the two groups were compared. Results Two out of 14 (14.3%) patients with COPD accepted lung volume reduction, which was significantly lower than that in patients with other diseases (6 out of 10, 60%, P＜0. 05). Post-transplantation chest X-ray showed that 50.0% and 25% of patients had an undeflected mediastinum in group Ⅰ and group Ⅱ, respectively (P＜0. 05).None of the other clinical parameters had significant difference between the two groups (P＞0.05).But a tendency of increase in mechanical ventilation, chest tube drainage time, air leak time, volume of chest drainage, and a tendency of decrease in times and volume of thoracentesis could be observed in group Ⅰ. Lung function test was not performed on 8 cases after transplantation. Sixteen cases (4 in group Ⅰ, 12 in group Ⅱ) had complete lung function data. There was no significant difference in FEV1 improvement after lung transplantation between the two groups (P＞0. 05). Conclusion Simultaneous graft or native lung volume reduction surgery is a safe and effective way of ameliorating lung volume mismatch after single lung transplantation, probably by improving ventilation-perfusion ratio.

Objective Bronchopleural fistula (BPF) is a common but potentially lethal complication after pulmonary resection.Currently,there is still controversy over the appropriate management strategy for BPF,especially when pleural space contamination develops.The purpose of this study was to evaluate the efficacy and safety of surgical repair fistulas combined with pedicled muscle flaps coverage in patients with early BPF after pulmonary resection based on our experience with 23 cases.Methods The clinical data for 23 patients who underwent surgical repair of early BPF from January 1999 to December 2010 at our hospital were reviewed.Thirteen patients had undergone a prior pneumonectomy and 10 patients had undergone a prior lobectomy.BPF occurred from postoperative day 5 to40 (mean postoperative day 21 ).Nine patients had a contaminated pleural space.After BPF was clearly diagnosed,prompt closed pleural drainage was instituted,followed by surgical repair of BPF.Four patients underwent a direct suture repair of fistula,ten patients underwent stump revision and suture closure,seven patients underwent stump revision and bronchoplasty or carina plasty,and a pedicled muscle flap was sewn to the edges of the fistula in two patients.The stump was covered with various muscle flaps,including interostal muscle flap in five cases,latissimus dorsi muscle flap in ten cases,serratus anterior muscle flap in six cases,and erector spinae muscle flap in two cases.Postoperatively,the pleural space was routinely irrigated and drained.Results No intraoperative or early postoperative death occurred.Four patients developed severs complications,including respiratory failure in two cases,pulmonary embolism in one case,and empyema in one case.All four cases recovered well after treatment.The mean duration of hospitalization was 33 days (range 8 - 120 days ).Surgical repair of BPF was successful in 21 cases (91.3％) but failed for 2 patients..BPF recurrence developed in only one patient two years postoperatively due to stump recurrence.He died of extensive metastatic disease 2 years after BPF recurrence.Conclusion Excellent results can be achieved by early surgical repair combined with stump pedicled muscle flaps coverage in patients with BPF who can tolerate reoperation,even if they have a contaminaled pleural space.

Objective To detect the mutation frequency of EML4-ALK fusion gene in lung cancer patients, and to inves-tigate the distribution of mutation character for EML4-ALK fusion gene in Ⅰ stage lung cancer patients and clinical features as well as provide a reference for the individual treatment of lung cancer .Methods 256 fresh tumor tissue specimens of lung cancer patients were screened from the specimen bank of our hospital and all the patients had accepted the surgical treatment from February 2013 to December 2014.Total RNA was extracted and then be transcribed into cDNA, the amplification-refrac-tory mutation system(ARMS) was used to detect mutation of EML4-ALK fusion gene.The results according to the positive con-trol, negative control and RNA quality control for EML4-ALK fusion type were analyzed.Results During the 256 patients ofⅠ stage lung cancer, there were 17 patients(6.64%) had mutations in EML4-ALK fusion gene.In lung adenocarcinoma mu-tation rate(16/207, 7.73%) was higher than that of lung squamous cell mutation rate(1/39, 2.56%), lung adeno-squamous mutation rate(0/4, 0) and large cell carcinoma(0/5, 0) of the mutation rate;young lung cancer patients( <63 years) of the mutation rate(14/139, 10.07%) was significantly higher than the high age of lung cancer patients(≥63 years old) mutation rate(3/117, 2.56%), P =0.009.EML4-ALK fusion with tumor invasion and visceral pleura group incidence (9/80, 11. 25%) was significantly higher than that of non-invasive and visceral pleura group incidence rate(8/176, 4.55%), P =0.045.Conclusion The occurence of EML4-ALK fusion correlates with patients’ age as well as whether visceral pleura is in-vaded, type 1 EML4-ALK fusion was detected more in phase I lung cancer patients.

BACKGROUNDTo explore the possibility of the staging of pulmonary angiography with multi slice spiral CT (MSCT) and to evaluate its value in making surgical plan for patients with lung cancer.

METHODSMSCT with two-segment injection and three-protocol scan was performed in 73 patients with central type lung cancer. According to the site and degree, the involvement of pulmonary artery was divided into three grades and blindly compared with the surgery and pathology.

RESULTSMSCT in 68 cases (93.15%, 68/73) was successfully performed. The involvement of central pulmonary artery was grade I in 4 cases (5.88%, 4/68), grade II in 9 (13.23%, 9/68), and grade III in 55 (80.88%, 55/68). All patients with grade I underwent lobectomy. There was remarkable difference of lobectomy ratio between grade II and III (Chi-square=64.03, P < 0.005) and also between IIIa and IIIb (Chi-square=68.69, P < 0.005). All patients with grade IIIc were ruled out from surgery.

CONCLUSIONSThe staging of pulmonary angiography by MSCT is useful to demonstrate the site and degree of involvement of central pulmonary artery and provides more precise evidence of images for making surgical plan.