Objective To observe the degree of liver su rface abnormality using high frequency probes and additional methods and to investigate the diagnostic value of semi-quatitative grading in liver fibrosis and cirrhosis. Methods One hundred and twenty-seven cases of cirrhosis (including 83 cases of hepatocelular carcinoma) confirmed by operation and pathology were enrolled in the group while 56 cases of non-cirrhotic patients with no clinical signs and negative surgical gross findings (operation for other kinds of tumors) served as the control. Five additional methods such as high frequency probes, harmonic technique, local zooming out, regulating focus and decreasing gain were used to observe the configuration and thickness of liver surface. Five-grade classification of liver surface was adopted as follows: thin and regular-grade 0; slightly thickened with increased echogenicity-grade Ⅰ; thickened like fine ripples-grade Ⅱ; significantly thickened with segmental incontinuence-grade Ⅲ; significantly thickened like waves-grade Ⅳ. Observation on configuration of the round ligament: thin, regular with the thickness ≤2 mm was considered as normal whereas thickened, irregular with increased echogenicity as abnormal. Results Of the 127 cases in the study group, 11 cases were grade 0, and grade Ⅰ 21 cases, grade Ⅱ 27 cases, grade Ⅲ 32 cases, grade Ⅳ 36 cases. In the control group there were 48 cases of grade 0 and 8 cases of grade Ⅰ-Ⅱ. The sensitivity, specificity and accuracy of liver surface detection with this method were 91.3-%, 85.7-%, 89.6-%, respectively. 75% (9/12 cases) patients with liver fibrosis and 95.5%- patients ( 64/67- cases) with cirrhosis were found with abnormality of hepatic ligaments in the study group. While only 4 cases ( 8.9-%) with abnormality appeared in the control group.Conclusions Grading of changes in liver surface might sensitively reflect their pathological changes. In addition, it would be a reliable method in the diagnosis of liver fibrosis and early stage cirrhosis as well as a semi-quatitative diagnostic tool for advancement of diffuse liver diseases.

OBJECTIVE To validate the anticancer effect of Angong Niuhuang pill (AGNH) and pinpoint associated molecular mechanisms using human cancer cells.METHODS Human MGC-803 gastric carcinoma and human BEL-7402 hepatocarcinoma cells were incubated with AGNH 9,30,90,300 and 900 mg·L-1 for 24,48and 72 h,respectively.Cell viability was detected with 3-(4,5-dimethylthiazol-2-yl) -5-( 3-carboxymethoxyphe-nyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assay and colony formation assay.Apoptosis was measured with flow cytometry and Hoechst 33258/PI staining.Change in mitochondrial membrane potential (△qψ) was detected by spectrofluorophotometer.RESULTS AGNH inhibited MGC-803 cell proliferation ( for 48 h,r =0.996,P =0.002; for72 h,r=0.756,P=0.024 ) and BEL-7402 cells (for 48 h,r =0.732,P=0.030; for72 h,r=0.702,P =0.037) in a concentration-dependent manner,as showed by MTS assay.AGNH inhibited colony formation on MGC-803 cells (r =0.914,P =0.011 ) and BEL-7402 cells (r =0.871,P =0.024) in a concentration-dependent manner for 24 h.Hoechst 33258/PI staining and flow cytometry assay showed that AGNH 900 mg·L-1 for 24 h induced apoptosis of MGC-803 and BEL-7402 cells,and the apoptosis rate was 27.2％ and 19.7％,respectively.Compared with normal control group,AGNH 900 mg·L-1 for 3 min decreased the mitochondrial membrane potential of MGC-803 and BEL-7402 cells to 15.9％ and 15.0％ of control group.CONCLUSION AGNH inhibits proliferation of human cancer cells.Apoptosis and depolarization of mitochondrial transmembrane potential are probablly its mechanism.

Objective To summarize the characteristics of low echo lesions by ultrasound findings in fat-ty liver,using real -time contrast -enhanced ultrasonography ( CEUS) for differential diagnosis .Methods The study was examed in 128 cases low echo lesions of fatty liver by using CEUS ,the malignant and the highly suspec-ted malignant and part of the benign lesions (in all the 52 cases)were punctured by ultrasound guided biopsy ,the rest of the 76 cases was confirmed benign by clinical comprehensive diagnosis ,were compared to the characteris-tics about ultrasound and contrast -enhanced ultrasound image and reviewed regular follow -up.We calculated the sensitivity,specificity,youden index and the area under the ROC curve by contrast -enhanced ultrasonography and ultrasound and apply for Kappa test for reliability analysis to contrast -enhanced ultrasonography and ultra-sound.Results There were 23 malignant lesions and 105 benign lesions in total of 128 patients.The sensitivity, specificity,youden index and the area under the ROC curve by contrast -enhanced ultrasonography and ultra-sound were 95.65%,98.10%,93.75% and 87.00%,91.43%,84.43%respectively.Compared contrast -en-hanced ultrasound examination diagnosis of low echo lesions in fatty liver with the clinical diagnosis performed good reliability(Kappa=0.922,P=0.045).Conclusion We should pay attention to low echo lesions in the fatty liver.contrast-enhanced ultrasound can effectively identify low echo lesions in the fatty liver ,and identify benign and malignant lesions in the liver ,and improve obviously the accuracy of diagnosis ,and reduce the misdi-agnosis rate.

Objective To evaluate the clinical value of contrast enhanced uhrasound(CEUS)for uhrasoundguided radiofrequency ablation(RFA)of liver metastasis.Methods One hundred and forty-one consecutive patients with liver metastasis asked for RFA treatment in our department.Of them,102 patients with received CEUS with SonoVue before RFA treatment.Eighty-six of the 102 patients were regarded as indications for RFA by CEUS(Group A).During the same period,another 39 patients who received conventional US without contrast before RFA were served as the control group(Group B).In Group A,the RFA protocol for each case was designed according to CEUS finding,which included perfusion feature,lesion number,size,shape,invasive range,location and relationship between tumor and surrounding structures.In Group B.the RFA protocol for each case was designed according to conventional ultrasound and CT/MRI result.Results In 102 patients who intended to receive RFA treatment,1 6 were excluded from RFA after CEUS examination.Of them,3 patients with 10 tumors received 6-10 sessions of chemotherapy and there were no enhancement within or around tumors.Another 13 cases were found that the invasive range being more than 8 cm in size,tumor number more than 7,and tumor location adhered to diaphragm and second hepatic helium by CEUS.In Grou0 A,CEUS detected additional 1-3 tumors in 36 patients(41.9%).The size range of the 58 new tumors was 8-15 mm.Of these,79.4%(46/58 tumors)were visualized in parenchymal phase.A total of 209 liver metastasis tumors were treated by RFA.CEUS before RFA demonstrated 49.7%(75/151 tumors)were 1arger in size compared with conventional US.Of these,69.3%(52/75 tumors)presented larger in arterial phase,the remaining 30.7%(23/75 tumors)presented larger in parenchymal phase,and the increased area was also ablated.On 1-3 months follow up with CT,the tumor necrosisrate in Group A was 94.7%(198/209 tumors),which was significantly higher than 87.6%(99/113 tumors)in Group B ( P=0.013). During follow-up period, local recurrence were found in 15 tumors (7.1 %) 2-17 months after REA and intrahepatic new tumors developed in 32 patients (37.2%) 2-17 months after RFA in group A,While local recurrence were found in 16 tumors (14.1%) and intrahepatic new tumors developed in 17 patients (43.5%) in group B ( P=0. 041, P ＞0.05, respectively). Conclusions CEUS provides important information for selecting candidation and designing optimal protocol for RFA in liver metastasis. The use of CEUS can increase tumor necrosis rate and decrease post-RFA tumor local recurrence,and then improve efficacy of RFA therapy.

Objective To evaluate laparoscopic appendicostomy in Malone antegrade continence enema (MACE).Methods 25 children with fecal incontinence undergoing MACE were divided into by laparoscopic technique (14 cases) and by laparotomy (11 patients).Results The operation time [(38.3 ±2.5) min vs.(60.5 ±3.6) min,t =13.7,P =0.00] was shorter in the laparoscopy group.All patients were followed up for 6 months to 3 years.No intestinal obstruction,fecal leakage in stoma and anal fecal incontinence or soiling happened.In laparoscopy group,the stomal stricture developed in 1 patient.The mucosa prolapse developed in 2 patients.In the laparotomy group,the stomal stricture developed in 2 patients.The mucosa prolapse in 1 patient.The symptom severity scoring for constipation and fecal incontinence after operation decreased in the laparoscopy group (12.1 ± 1.4 vs.33.7 ± 1.5,t =28.4,P =0.00),laparotomy group (12.5 ± 1.6 vs.33.3 ± 1.7,t =25.36,P =0.00).While the irrigation volume [(607±151) mlvs.(594±161) ml,t=0.17,P=0.87],MACE scoring (22.1 ±1.4vs.22.0±1.7,t =0.18,P =0.86) and symptom severity scoring for constipation and fecal incontinence (12.1 ± 1.4 vs.12.5 ± 1.6,t =0.46,P =0.65) were not statistically different.Conclusions The laparoscopic technique can make the MACE easier to operate and less traumatic.

Two hundreds postmenopausal women with osteopenia, aged 45-80, were randomly divided into 4 groups, and received different drug interventions. After treatment for 12 months, the lumbar spine bone mineral density(BMD)and total hip BMD in alendronate group increased significantly(3.5% and 2.6%, both P＜0.05), the lumbar spine BMD raised 2.0% in selective estrogen receptor regulator group(P＜0.05). Bone turnover indices improved in both groups(all P＜0.05). No change in BMD or bone turnover indices was found in patients treated with active vitamin D3and calcium.

Objective To investigate the risk factors for postmenopausal osteoporosis in Shanghai.Methods Five hundred postmenopausal community-dwelling women aged 45-80 years were recruited. The case-control study was performed from June 2008 to September 2008.A total number of 250 women with postmenopausal osteoporosis identified with their bone mineral density (BMD) were selected as case group, and 250 non-osteoporosis women were selected as control group. BMD was measured by dual energy X-ray absorption (DEXA). Results Univariate logistic regression analysis showed that age, eduction level, occupation, years since menopause, BMI, use of calcium,historyofnon-violencefracture,fall,diabetesmellitus,chronicgastricdiseases, gastrointestinal resection and diarrhea were related to osteoporosis.Multiple logistic regression showed that age, years since menopause and nutritional status were the risk factors for osteoporosis. ConclusionsThe occurrence of osteoporosis is related with many factors in postmenopausal women in Shanghai, and women with early menopause, low BMI and older age should pay more attention to the prevention and treatment of osteoporosis.

OBJECTIVETo explore the value of ultrasound-guided percutaneous radiofrequency ablation (RFA) in designing the indication, treatment protocol and operational skills for patients with primary hepatocellular carcinoma (HCC) near the liver surface.

METHODSSixty-one HCC patients with 69 lesions, confirmed by clinical examination and pathology, underwent percutaneous radiofrequency ablation. The study included 40 cases of liver function Child-Pugh grade A and 21 cases of grade B. The average size of tumors was (3.8 ± 1.2) cm, tumor diameter ≥ 4 cm accounted for 39.1% (27/69 lesions), and the average age was 58.2 years (range, 35-76 years). Taking comprehensive measures, such as intraperitoneal injection of saline adjacent to the tumor before RFA, increasing the puncture sites on the surface of tumor to avoid overlapping of the central portion of tumor, repeated ablation of the needle track to reduce needle tract metastasis, avoid vertical puncture, and other additional measures, to improve the inactivation of tumors adjacent to the liver surface. Enhanced CT/MRI was performed to evaluate the curative effect at 1, 3, 6 and 24 months after the treatment.

RESULTSThe inactivation rate of tumor was 98.6% (68/69 lesions) and local recurrence rate was 5.8%(4/69) after RFA. The tumor-related marker AFP was 1 000-1 500 ng/ml before and reduced to (98.5 ± 42.5) ng/ml after radiofrequency ablation, among them returned to normal in 13 cases (21.3%). Since the ablation area was rather small, the level of serum alanine aminotransferase was elevated only to (148.5 ± 38.5) U/ml at one week after RFA and returned to normal at (1.8 ± 0.6) week after RFA. No patient experienced severe liver dysfunction. The local HCC recurrent rate after RFA was 5.8%(4/69 lesions) and intrahepatic heterotopic recurrence rate was 24.6% (15/61). The 20-61 months follow-up showed that the 1-, 2- and 3-year survival rate was 83.6%, 57.3% and 44.2%, respectively.

CONCLUSIONSUltrasound-guided percutaneous radiofrequency ablation provides an effective minimally invasive treatment for primary HCC near the liver surface. Taking some additional measures such as intraperitoneal injection of saline, increase of percutaneous puncture sites, and avoiding vertical needle puncture, may reduce complications and improve the therapeutic outcome. RFA is one of effective and minimally invasive treatment and causing less liver damage for primary HCC near the liver surface.

Adult ; Aged ; Biomarkers, Tumor ; blood ; Carcinoma, Hepatocellular ; blood ; pathology ; surgery ; Catheter Ablation ; methods ; Humans ; Liver ; pathology ; Liver Neoplasms ; blood ; pathology ; surgery ; Magnetic Resonance Imaging ; methods ; Middle Aged ; Neoplasm Recurrence, Local ; Survival Rate ; Treatment Outcome ; Tumor Burden ; Ultrasonography, Interventional

Objective:To evaluate the application value of serum neuron-specific enolase(NSE) in the diagnosis of neuroblastoma in children.Methods:The clinical data of 98 children with neuroblastoma admitted to Children's Hospital of Shanxi Province from January 2010 to January 2018 were retrospectively analyzed(study group), and 40 healthy children with physical examination during the same period were selected as control group.The serum NSE levels were detected in the study group at the time of diagnosis and after treatment, and in the control group at the time of physical examination, to evaluate the effectiveness of NSE level changes in the diagnosis of neuroblastoma in children.Results:The serum NSE level in the study group[(98.61±10.42)μg/L] was higher than that in the control group[(15.31±1.16)μg/L]( t=50.325, P<0.05). At the time of diagnosis, the serum NSE levels of stage II, III and IV were (31.56±12.82)μg/L, (78.65±20.1)μg/L and (127.45±32.48)μg/L, respectively, showed an increasing trend( F=111.556, P=0.000). The serum NSE level of the study group after treatment[(62.48±7.46)μg/L] was lower than that before treatment[(98.61±10.42)μg/L]( t=27.910, P<0.05), and the serum NSE levels of children at different stages were lower than those before treatment(all P<0.05). The receiver operating characteristic (ROC) curve was drawn with serum NSE as the variable, showed the area under the curve of 0.815, the Yoden index of 0.534, the sensitivity of 71.43%, and the specificity of 90.82%. Conclusion:Serum NSE detection plays an important role in the diagnosis of neuroblastoma in children, and is conducive to the judgment of the severity of the disease, the treatment effect, with high diagnostic performance.It is worthy of clinical promotion.

Objective To investigate the efficacy of Saccharomyces boulardii combined with ur-sodeoxycholic acid in the treating rectal ulcerative colitis(UC)and its influence on intestinal mucosal barrier function.Methods A total of 88 patients with rectal UC were randomly divided into observa-tion group and control group,with 44 cases in each group.The scores of main symptoms(abdominal pain,diarrhea,purulent stool),score of the Inflammatory Bowel Disease Questionnaire(IBDQ),lev-els of inflammatory factor indicators[interleukin-6(IL-6),interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α)]and levels of intestinal mucosal barrier function indicators[the ratio of urinary lac-tolic acid to mannitol(L/M),serum D-lactic acid(D-LA),serum diamine oxidase(DAO),and ser-um lipopolysaccharide(LPS)]were compared between the two groups before and after treatment.The incidence of adverse reactions were compared between two groups.Results After treatment,the scores of abdominal pain,diarrhea and purulent stool in both groups were significantly lower than those before treatment,while the IBDQ score was significantly higher than that before treatment,and the scores of abdominal pain,diarrhea and purulent stool in the observation group were significantly lower than those in the control group,while the IBDQ score was significantly higher than that in the control group(P＜0.05).After treatment,the levels of serum D-LA,DAO,LPS and urinary L/M in both groups reduced significantly,and the levels of these indicators in the observation group were signifi-cantly lower than those in the control group(P＜0.05).After treatment,the levels of serum IL-6,TNF-α and IL-1β in both groups reduced significantly,and the levels of these indicators in the observation group were significantly lower than those in the control group(P＜0.05).The total ef-fective rate inthe observation group was 86.36％,which was significantly higher than 68.18％in the control group(P＜0.05).There were no significant differences in incidence rates of adverse re-actions such as lower abdominal pain,allergies and refractory constipation between two groups(P＞0.05).Conclusion Saccharomyces boulardii combined with ursodeoxycholic acid is effective in the treatment of patients with rectal UC,which can effectively improve symptoms such as abdominal pain,diarrhea and purulent stool,inhibit the inflammatory response of the body,and alleviate dam-age to the intestinal mucosal barrier.