Objective To study the value of the early enhanced morphology in three dimensional dynamic contrast-enhanced and digital subtraction MRI in diagnosing breast cancer.Methods Three dimensional dynamic contrast-enhanced and digital subtraction MRI of breast neoplasm in 46 patients(52 lesions)verified by histopathology were performed before operations.MR imaging data were analysed.On the base of early-phase enhanced rate,peak time,blood vessel morphology and time-signal intensity curve,the diagnostic values of the early enhanced morphology of lesions were evaluated.Results In the 37 malignant breast lesions,31 lesions were enhanced from the center to the margin(83.8%,31/37),14 benign breast lesions were enhanced from the margin to the center(93.3%,14/15).The special features of breast cancer in three dimensional dynamic contrast-enhanced and digital subtraction MRI were circular enhancement and the contrast medium filled from the margins to the centre of lesions in middle-later phase,its diagnostic sensitivity,specificity and accuracy were 97.3%,93.3% and 96.2% respectively.Conclusion The morphological features of three dimensional dynamic contrast-enhanced and digital subtraction MRI has obvious advantages in diagnosing breast cancer.

Objective To value diffusion-weighted imaging and ADC value measurement of benign and malignant axillary lymph node identification value. Methods From 2006-06 to 2008--02, by collecting in the hospital for breast dynamic con-trast-enhanced scans and diffusion-weighted imaging, 217 lesions in 56 cases with a clear outcome of the surgery and pathology and/or needle biopsy results were retrospectively analyzed.Results The DWI could accurately show the lymph node of the armpit abnormality, 163 cases of 47 breast cancer cases with lymph node metastasis showed high signal in DWI image that did not decrease with increasing b value, similar to the 54 cases of 9 benign enlarged responsive prolifer-ative lymph nodes. But the former showed higher signal than the later. The ADC values were(1.017±0.114)×10-3mm2/s and (1.905±0.136)×10-3mm2/s respectively, and showed significant difference between two groups (P<0.05). Conclusion The dynamic contrast-enhanced subtraction MR technology benign and malignant breast lesions has high diagnosis and differ-ential diagnosis importance. DWI and ADC value measurement is a safe, non-invasive, accurate and rapid diagnosis of metastasis axillary lymph nodes and benign proliferative response of the lymph nodes means.

Objective To study the diagnostic value on mammary gland focal benign and malignant with MRI digital sub- traction. Methods By analyzing 109 histopathology cases of breast neoplasm which can be use three dimensional dynamic contrast and MRI digital subtraction. Based on early-phase enhancement rate peak time, time-signal intensity curve and enhanced lesions way, the diagnostic value on it was evaluated. Results The specificity signs of breast carcinoma are en- hanced ways on MRI enhancement scanning. The filling type is contrast agent filled from edge to centre. The sensitivity is 82.9%; specificity is 79.0%; accurate rate is 80.7%. Conclusion The aggrandizement form on filling type of breast MRI digital subtraction scanning focus has obvious advantages in breast carcinoma diagnosis.

Contracture and spasticity of ankle joints were major sources of disability in neurological impairment including stroke and cerebral palsy, etc. The manual stretching used in physical therapy might be laborious and time-consuming to the therapists and the outcome was dependent on the experience and the subjectiveend feelingof the therapists. A device was developed that could safely stretch the an-kle joint to its extreme positions with quantitative control of the resistance torque and stretching velocity. Furthermore, it could satisfy a strong need for quantitative and objective measures of the impairment and rehabilitation outcome. This was just the meaning intelligent stretching referred to. This article described the origin of the concept of intelligent stretching and its definition, operational principle, and su-periority and weakness, as well as its application in ankle joint spasticity and contracture in patients with stroke and cerebral palsy.

Objective To evaluate the efficacy and safety of holmium laser in situ fenestration for aortic arch diseases during thoracic endovascular repair.Methods The clinical data of 12 patients with aortic dissection or aortic pseudoaneurysm was analyzed from Nov 2016 to Feb 2017.After thoracic aorta stenting the left common carotid artery and left subclavian artery were reconstructed using holmium laser in situ fenestration.Results The success rate of operation was 100％,no type Ⅰ or type Ⅱ endoleak occurred,1 case complicated with left retinal artery occlusion.All patients were followed up for 6 to 9 months,the mean time was 7.3 months.The location of the stent graft was good.The left carotid artery and left subclavian artery kept patent.Conclusions The laser in situ fenestration technique can provide the opportunity of stenting for patients with aortic arch lesion near the branch.Short term follow-up results were satisfactory.

Objective To investigate the association between serum alkaline phosphatase (ALP) and type 2 diabetes mellitus (T2DM) with nonalcoholic fatty liver disease (NAFLD). Methods A total of 599 patients with T2DM who were hospitalized in Department of Endocrinology, Affiliated Hospital of Jiangsu University, from July 2016 to December 2018 were enrolled as subjects. According to the presence or absence of NAFLD, the patients were divided into NAFLD group with 286 patients and non-NAFLD group with 313 patients, and according to the results of abdominal ultrasound, the patients with NAFLD were divided into mild group with 111 patients, moderate group with 105 patients, and severe group with 70 patients. General clinical data were compared between groups. The independent samples t - test was used for comparison of normally distributed continuous data between two groups, and an analysis of variance was used for comparison between three groups; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between three groups; the chi-square test was used for comparison of categorical data between groups. Pearson correlation analysis and Spearman correlation analysis were used to investigate the correlation between ALP and clinical indices, and a logistic regression analysis was used to investigate the influencing factors for NAFLD. Results Compared with the non-NAFLD group, the NAFLD group had significantly higher proportion of patients with history of hypertension ( χ 2 =7.864, P < 0.05), systolic blood pressure ( t =-2.226, P < 0.05), diastolic blood pressure ( t =-3.800, P < 0.05), body mass index (BMI) ( t =-11.842, P < 0.05), waist circumference (WC) ( t =-9.150, P < 0.05), fasting insulin (FINS) ( Z =-6.173, P < 0.05), fasting C-peptide ( t =-5.419, P < 0.05), serum uric acid ( t =-4.957, P < 0.05), low-density lipoprotein cholesterol ( t =-2.702, P < 0.05), triglyceride ( Z =-9.376, P < 0.05), total cholesterol (TC) ( t =-3.016, P < 0.05), Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) ( Z =-5.794, P < 0.05), alanine aminotransferase (ALT) ( Z =-6.737, P < 0.05), aspartate aminotransferase (AST) ( Z =-4.389, P < 0.05), gamma-glutamyl transpeptidase (GGT) ( Z =-7.764, P < 0.05), and ALP ( t =-2.833, P < 0.05), as well as significantly lower age ( t =2.184, P < 0.05) and high-density lipoprotein cholesterol ( Z =-5.273, P < 0.05). The severity of NAFLD (mild, moderate or severe) was positively correlated with age ( r s =0.140, P < 0.05), BMI ( r s =0.239, P < 0.05), WC ( r s =0.222, P < 0.05), FINS ( r s =0.191, P < 0.05), HOMA-IR ( r s =0.218, P < 0.05), ALT ( r s =0.188, P < 0.05), AST ( r s =0.279, P < 0.05), GGT ( r s =0.202, P < 0.05), and ALP ( r s =0.361, P < 0.05). In the patients with T2DM and NAFLD, ALP was positively correlated with HbAlc ( r =0.149, P < 0.05), fasting plasma glucose ( r =0.146, P < 0.05), HOMA-IR ( r s =0.132, P < 0.05), TC ( r =0.151, P < 0.05), ALT ( r s =0.210, P < 0.05), AST ( r s =0.192, P < 0.05), and GGT ( r s =0.297, P < 0.05). The logistic regression analysis showed that ALP was an influencing factor for NAFLD in patients with T2DM (odds ratio=1.013, 95% confidence interval: 1.004-1.023, P < 0.05). Conclusion Elevated serum ALP is a risk factor for T2DM with NAFLD and is closely associated with hyperglycemia, insulin resistance, and hyperlipemia, and ALP may play a role in the development and progression of T2DM and NAFLD.