Objective To develop a protocol for ultrasound-guided percutaneous radiofrequency ablation (RFA) on hepatic tumors larger than 3.5 cm in diameter, and to evaluate its role in ablation treatment. Methods Mathematical analysis was performed to generate the preoperative protocol which included the least ablation (sphere) number and the optimal overlapping mode and procedure for adequately ablating a large and spherical target lesion. The target ablation volume consisted of a tumor plus a 0.5- 1.0 cm tumor-free margin. The operation method for electrode placement was also described. Based on this mathematical protocol, 113 patients with 124 hepatic tumors [( 4.75? 0.92)cm in diameter, ranging from 3.6- 7.0 cm] were enrolled and treated. Seventy-one patients had 76 primary and 42 had 48 metastatic hepatic tumors. Results Totally 554 ablations (electrode placements) were performed in 124 tumors. The tumor complete necrosis rate was 87.9% (109/124), the local recurrence rate 24.2% (30/124), the estimated mean time to local recurrence 17.3 months. Twenty-five patients had received 38 retreatments for the local recurrence (17 received one time, and 8 received two or three times). Major complications were found in 7 patients (6.2 %). Of them, only one patient who suffered from colon perforation one week after RFA treatment required surgical intervention. Conclusions A theoretic basis and clinical guidance in RFA of hepatic tumors larger than 3.5 cm might be provided. Treatment results indicated that the protocol might probably be used to improve complete necrosis rate and reduce local recurrence rate in ablation therapy. The protocol was firmed effective and feasible.

ObjectiveTo evaluate prognostic factors affecting local tumor progression after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC).MethodsA total of 246 HCC patients (343 lesions) underwent RFA treatment in our department and were enrolled into this study.The average tumor size was 3.7 cm ( range 0.9 ～ 3.7 cm).Regular follow-up with enhanced CT was performed to evalutate the treatment results.Kaplan-Meier model and log-rank test were used in univariate analysis and COX regression model was used in multivariate analysis to identify risk factors for local tumor progression.ResultsThe local tumor progression rate was 11.4％ (39/343 lesions),and the average time from initial RFA to local tumor progression was 12.0 months.Univariate analysis indicated tumor size ( P ＜0.001 ),close to intrahepatic vessels ( P ＜0.001),tumor boundary ( P =0.020),pathological grade( P =0.010) and CEUS before RFA ( P =0.001) as risk factors for local progression.The following factors were identified as independent prognostic factors for local tumor progression by multivariate model:tumor size (P ＜ 0.001),isolated or close to intrahepatic vessels( P ＜0.001) and CEUS before RFA(P =0.018).ConclusionsTumor size,CEUS before RFA and close to intrahepatic vessels are the most important factors for local progression after RFA.Being awaring of possible risk factors for local tumor progression may increase the treatment efficacy and help to promote the use of RFA technique.

One hundred and sixteen patients with lower limb fracture were screened by Doppler ultrasound for deep vein thrombosis(DVT) of bilateral lower extremities within the first 72 h, d7 and d21 after fracture. Results showed that DVT was detected in 31 (26. 7% ) out of 116 cases within 72 h; at d7 and d21 DVT was detected in 3 and 1 patient respectively with a cumulated DVT rate of 30. 2% in 3 weeks.Serial Doppler ultrasonography is of value in screening for DVT of the lower extremities in patients with lower limb fracture at early stage.

Objective To investigate the surgical method and clinical curative results of acetabulum top compression fractures with sea gull sign. Methods Data of 14 patients who had acetabulum top compression fractures with sea gull sign were retrospectively analyzed and were accepted surgical therapy and followed up. There were 5 females and 9 males, aged from 28 to 71 years (average, 49.9 years). The pre-operative time was from 4 to 14 days (average, 9 days). Letournel-Judet fracture classifica-tion:eight cases for the anterior column+posterior semi-transverse, six cases for a simple anterior column. Three patients with lum-bar compression fracture, two patients with tibial plateau fracture, one patient with multiple rib fractures. All patients were accept-ed open reduction and bone graft and internal fixation through ilioinguinal approach or ilioinguinal approach+Kocher-Langenbeck approach. The quality of fracture reduction was assessed according to the Matta reduction criterion after operation. The hip func-tion was evaluated according to Matta. Results 14 patients were followed up from 6 to 60 months (average, 36 months). All pa-tients reached bone healing;healing time was from 3 months to 4 months (average, 3.4 months). According to the Matta reset stan-dard after operation, there were 6 excellent cases, 5 good cases, 2 fair cases, 1 poor case, the excellent and good rate was 78.5%(11/14). The Matta was from 10 to 18 scores (average, 16.4 scores), 5 excellent cases, 5 good cases, 3 fair cases, 1 poor case, the ex-cellent and good rate was 71.4%(10/14). Traumatic arthritis occurred in 3 patients. Pain was serious in two patients and disap-peared after total hip joint replacement. Pain was mild for one patient and disappeared after accepted non steroidal painkiller. One patient had heterotopic ossification after operation, which was not treatmented because of no obvious symptom. Conclusion The appropriate operation time of acetabular roof compression fracture with sea gull sign was from 5 to 10 days after fracture, which was no more than two weeks had best. Through ilioinguinal approach or ilioinguinal approach+Kocher-Langenbeck approach, the articular surface could be reduced excellent and got sufficient bone graft. The clinical efficacy was satisfactory after operation.

Objective To compare the contrast-enhanced ultrasonography (CEUS) manifestations of pNENs with the pathological changes and to explore the clinical value of CEUS in diagnosis of pNENs. Methods The CEUS of sixteen pathologically diagnosed pNENsfrom April,2012 to February,2014 were retrospectively observed.The CEUS of thirty pathologically diagnosed pancreatic carcinomas during the same period were taken as the control group.The enhancement extent and enhancement patterns of CEUS in pancreatic tumors were analyzed. The specimens of pNENs were stained with HE and CD34 immunochemistry.The grading of interstitial content and Ki-67 index were obtained on HE-stained slices and microvascular density(MVD) were obtained on CD34 immunochemistry stained slices.Spearman rank test analysis was employed to analyze the correlation.Results Among the 16 cases of pNENs,12 cases (75.0%) demonstrated hyper-or iso-enhancement,which included 6 cases (37.5%) showing homogeneous enhancement and 6 cases (37.5%) showing inhomogeneousen hancement,and the other 4 cases demonstrated hypo-enhancement. Among 30 cases of pancreatic carcinomas,25 cases (83.3%) demonstrated hypo-enhancement and 5 cases (16.7%) hyper- or iso-enhancement,and 21 cases (70.0%) demonstrated homogenous enhancement,and 9 cases(30.0%)inhomogeneous enhancement.Taking hyper-or iso-enhancement on CEUS as the diagnostic criteria,its diagnostic sensitivity,specificity,positive predictive value,negative predictive value,and accuracy were 75.0%,83.3%,70.6%,86.2%,80.4%respectively.Negative and positive correlation of the enhancement extent of pNENs with the interstitial content(r =-0.880,P < 0.001) and MVD (r =0.658,P =0.003) were observed,respectively.Six tumors with inhomogeneous enhancement contained cystic degradation or necrosis under microscope. Conclusions CEUS is an effective and non-invasive diagnostic approach for pNENs and can reflect the pathological changes.Hyper-or iso-enhancement of CEUS is typical appearance of pNENs.

To explore the binocular disparity information for children with a normal vision based on computer-assisted evaluation system.We examined the random dot zero-order disparity,line zero-order disparity,2nd-order disparity and random dot motion parallax for 97 children with normal vision.And 94 children reached 100″ vision disparity both in random dot zero-order disparity and line zero-order disparity (pass rate of 96.9％) ; all 94 cases passed the 2nd-order disparity and random dot motion parallax.Thus children with a normal vision develop their stereopsis.

Objective To analyze the changes of celluar and humoral immunity in children with juvenile idiopathic arthritis(JIA),as well as the changes in different subtypes,and to investigate the role of cellular and humoral immunity in the pathogenesis of JIA.Methods Ninety-two JIA subjects and 82 controls(healthy children) were included into this study.The levels of T lymphocyte subsets,natural killer (NK)cells,and B cells were analyzed by using flow cytometry.The serum interleukin-1 (IL-1),tumor necrosis factor-α (TNF-α),interleukin-l0 (IL-10),transforming growth factor-β(TGF-β) levels were detected by using enzyme-linked imnmunosorbent assay (ELISA).The serum IgG,IgM,IgA and C3,C4 levels were detected by using velocity scatter turbidimetry.Independent t-test,One-Way ANOVA test and Pearson analysis were adopted for data analysis.Results 1.In the group of JIA,the levels of CD3,CD4,IL-1,TNF-α,IgG,IgM,IgA and C3 were higher than those in the control group(all P ＜ 0.05),while the levels of CD4CD25,CD8,NK cells,IL-10 and TGF-β were lower than those in the control group(all P ＜0.05),and the ratio of CD4/CD8 was higher than that in the control group (P ＜ 0.05).2.In the group of systemic-onset JIA (so-JIA),the levels of CD4,IL-1,TGF-β,IgG,IgM,IgA,C3 and the ratio of CD4/CD8 were higher than those in the oligoarthritis JIA group(all P ＜ 0.05),while the levels of CD4CD25,CD8,IL-10 were lower than those in the oligoarthritis JIA group(all P ＜ 0.05).In the group of polyarthritis JIA,the levels of IL-1,TNF-α,IgG,IgM and IgA were higher than those in the oligoarthritis JIA group(all P ＜0.05),while the levels of CD4CD25,CD8,IL-10 were lower than those in the oligoarthritis JIA group (all P ＜ 0.05) ; In the group of so-JIA,the levels of CD4,TGF-β,C3 and C4 were higher than those in the polyarthritis JIA group (all P ＜ 0.05).3.The value of IL-1,TNF-α were positively correlated with that of C-reactive protein (CRP),erythrocyte sedimentation rate(ESR) in the JIA group(all P ＜ 0.05),while the value of IL-10,TGF-β was negatively correlated with that of CRP,ESR(all P ＜ 0.05).Conclusions There are cellular immunity and humoral immunity disorders in the JIA.Cellular immunity and humoral immunity are all involved in the pathogenesis of JIA.T helper cells are activated and Th1 cytokines increase,suppressive T cells,regulatory T cells impairment and suppressive cytokines decrease but immunoglobin increase,which involve in auto inflammation reaction and articular destruction in JIA.The immunity disturbances are more striking in so-JIA and polyarthritis JIA.IL-1,TNF-α,IL-10 and TGF-β are correlated with the disease activity.

Objective To analyze the findings of recurrent/residual caner after thyroidectomy for thyroid cancer in both ultrasonography (US) and contrast-enhanced CT (CECT),and to assess the diagnostic value of combination of these two modalities.Methods Forty-six patients with recurrence/ residue of thyroid cancer underwent both high-frequency US and CECT examinations and were enrolled in this study.The imaging features on US and CECT were reviewed and diagnostic accuracies for local residual lesions and cervical lymph node metastasis were evaluated according to pathological results.Results In 46 patients,the average period between thyroidectomy and diagnosis of recurrent/residual cancer was (14.6 ± 12.1) months(range,7 days-10 years).Twenty patients had local recurrent tumors at the surgical bed and the average size of tumors was 2.1 cm(range,0.5-4.6 cm).On US finding,the recurrent/residual tumors were hypoechoic in 60 ％ of cases,had microcalcification in 40 ％.Cervical lymph node metastasis were found in 40 patients,and 75％ of them were located in zone V[.The smallest size of abnormal lymph node which can be detected by US was 3 mm.In cases of lymph node metastasis,12 cases (30％) became cystic,10 (25 ％) presented microcalcifications,and 5 (12.5 ％) showed microcalcifications and cystic change within a lymph node.Microcalcifications,cystic change and hyperechoic appearance within a lymph node suggested malignant.The detection rate of US and CECT in the local recurrent/residual cancer were 90％ and 90％,respectively.The detection rate of cervical lymph nodes metastasis were 80 ％ and 72.5 ％,respectively.The diagnostic accuracy of US and CECT in local recurrence,cervical lymph node metastasis and both were 65％,67.5％ and 65.2％ vs 75％,55％ and 65.2％,respectively (P ＞ 0.05 for all comparisons).the diagnostic accuracy of combination of US and CECT were increased to 86.4％,77.5％ and 91.3％,respectively.US combined with CECT significantly improved the diagnostic capability compared with US or CECT alone(P ＜0.05).Conclusions US should be used as the first choice of imaging examination for post-thyroidectomy of thyroid cancer.US combined with CECT could further increase the diagnostic accuracy in recurrent/residual thyroid cancer.

Objective To evaluate the role of contrast-enhanced ultrasound (CEUS) for preoperative detection of colorectal liver metastases.Methods 42 consecutive patients with colorectal liver metastases confirmed by histopathology after surgery were recruited in the study.They all had undergone preoperative CEUS examination with contrast agent SonoVue.The number,location and size of the hepatic lesions found by CEUS were correlated with postoperatively histopathologic results on a lesion-by-lesion basis.Results 96 liver metastases in 42 patients with colorectal cancer had been resected and confirmed by histophathology.The size of the metastatic lesions ranged from 0.3～8.5 cm [average (2.6 ± 1.8)cm].From one to eight metastatic lesions were detected in one patient.21 (21.9％) metastatic lesions were equal to or less than 1.0 cm.86 of 96 metastatic lesions were correctly depicted by CEUS,with a sensitivity of 89.6％.And the sensitivity for metastatic lesions equal to or less than 1.0 cm was 71.4％ (15 of 21 tumors) by CEUS.35 metastatic lesions were found between the portal venous phase and late phase by CEUS and 19 (54.3％) metastatic lesions among them could not be detected at conventional ultrasound.The curative resection was performed in 37 (88.1％) of 42 patients.With 3 - 39 months follow-up,the intrahepatic recurrence rate within two years was 32.4％ (12 of 37 patients) and the one-year survival rate was 90.0％.Conclusions CEUS is highly sensitive for detecting liver metastases resulted from colorectal cancer,especially for small metastatic lesions.CEUS is helpful to choose reasonable therapeutic strategies and can be regarded as one of the most importantly and noninvasively preoperative imaging modalities.

Objective To study the changes of gastrin 17 (G17) and pepsinogen (PG) after gastric bypass surgery in gastric antrum resection, and the influences of different surgical methods on postoperative peptic ulcer. Methods Clinical data of 63 patients with gastric bypass surgery in our hospital from October 2013 to October 2015 were divided into resection of pyloric antrum group (n=33) and preserved pyloric antrum group (n=30). The values of G17, PGⅠ, PGⅡand PGⅠ/PGⅡwere detected by enzyme linked immunosorbent assay at 1 month, 6 months and 12 months after operation. The correlation between the different surgical methods and the incidence of peptic ulcer was analyzed between two groups. Results The G17 levels were significantly decreased in resection of pyloric antrum group 6 and 12 months after operation than those in preserved pyloric antrum group (P<0.05). Compared with preserved pyloric antrum group,PGⅠ and PGⅡ levels was significantly decreased 12 months after operation (P<0.05). There was no significant difference in the ratio PGⅠ/PGⅡat 1 month, 6 months and 12 months after operation between two groups (P>0.05). There was no significant difference in postoperative peptic ulcer between two groups (P>0.05). Conclusion Gastric bypass after resection of the pyloric antrum can reduce the postoperative secretion of G17, PGⅠ and PGⅡ, but which can not reduce the incidence of postoperative anastomotic ulcer.