Objective To summarize the manifestation of solid pseudopapillary tumor of the pancreas (SPTP) on ultrasound and contrast-enhanced ultrasound (CEUS) and to investigate the diagnostic value of CEUS. Methods The ultrasound and CEUS images of six patients with SPTP confirmed by pathology were reviewed. According to CEUS record,the enhanced and wash-out time,enhanced speed and degree of tumor were analyzed. Results On ultrasound, SPTP presented as solid, well-circumscribed masses, usually heterogeneous in echo texture, and some of them contained macro-calcification. On CEUS, the tumor enhanced simultaneously or slightly late compared with normal pancreatic tissues. The contrast agent washed out quickly in all tumors than in normal pancreatic tissues. The enhanced degrees were equal to or less than that of the normal pancreatic tissues. Some tumors showed capsule and septum enhancement. Conclusions The manifestation of SPTP on CEUS had some features and may be helpful for differentiation diagnosis combine with ultrasound.

Objective To evaluate the dosimetric errors of organs-at-risk (OARs) induced by the optimal auto-segmentation using Mim Maestro based on dose calculation and measurement.Methods The Mim atlas library composed of 240 nasopharyngeal carcinoma,breast cancer,and rectal cancer patients that were retrospectively selected was used for the auto-segmentation of OARs on the CT images of corresponding regions in 76 patients.Relative to the manual contouring,one optimal case was selected from each site based on conformity index (CI),mean distance to conformity (MDC),relative volume difference (Dv％),DICE,sensitivity index (Se.Idx),and inclusion index (Inc.Idx).Treatment plans were made to satisfy the DVH constraints of OARs based on auto-contours,and then the dose errors to the actual organs were evaluated in terms of calculation and measurement.The paired t-test (normal distribution) or rank sum test (non-normal distribution).Results Significant differences were observed in the 76 patients between the manual and automated segmentation (P＜0.05).For the optimal cases,the DICE index of various OARs ranged from 0.43 to O.98,and 73％(16/22) of DICE values were higher than 0.70.The calculated dose errors to various OARs were (-1.15±15.94)％(95％ CI:-8.21％ to 5.92％) (mean dose) and (-6.53±21.13)％ (95％ CI:-15.90％ to 2.84％) (maximum dose).The measured dose errors were (-2.43± 24.52)％ (95％ CI:-13.30％ to 8.44％)(mean dose) and (-3.38±20.87)％(95％ CI:-12.63％ to 5.87％)(maximum dose).Conclusion Without human interference,even the optimal auto-segmentation results are not clinically acceptable for treatment planning.

Objective To explore the diagnostic value of contrast enhanced ultrasound (CEUS) by comparison with enhanced MRI.Methods Thirty-two cases with pancreatic cystic lesions confirmed by surgery or biopsy were enrolled.Ultrasound,CEUS and MRI were applied respectively for the diagnosis of 32 cases.The diagnostic ability of different imaging methods were compared according to pathological results as the gold standard.Results The 32 cases include 8 cases of serous cystadenoma,6 cases of mucinous cystic neoplasm,3 cases of intraductal papillary mucinous neoplasm,4 cases of solid pseudopapillary tumor,3 cases of neuroendocrine tumor,6 cases of pancreatic carcinoma,1 case of cyst and 1 case of inflammatory myofibroblastic tumor.The diagnostic accuracies of ultrasound,CEUS and MRI were 46.88％ (15/32),75.00％ (24/32) and 78.13％ (25/32) respectively.There was no significant difference between the diagnostic accuracies of CEUS and MRI (P =0.768).The diagnostic accuracies of CEUS and MRI were higher than that of ultrasound (P ＜0.05).Conclusions CEUS has obvious superiority over ultrasound in the diagnostic accuracy of pancreatic cystic lesions.The diagnostic ability of CEUS is similar to that of MRI.

Objective To explore the manifestation of pancreatic metastases (PM)using contrast‐enhanced ultrasound (CEUS). Methods Eleven patients with PM confirmed by pathology or CT/MRI combined with clinical data were analyzed retrospectively. The manifestation on conventional ultrasound and the enhancement appearance on CEUS were analyzed. Results The primary malignant tumors included lung cancer(n=6), breast cancer(n=1), renal clear cell carcinoma(n=1), gastric cancer(n=1), rectal cancer(n=1)and leiomyosarcoma of uterus(n=1). Eight patients had one lesion and three were multiple. The maximum lesion diameter was 2. 0-5. 0cm. Eight of the 11 patients showed hypoechoic on conventional US. Three patients were diagnosed as probably PM, one probably malignant and 7 undetermined by US. In the early stage of CEUS, two patients showed hyper‐enhancement, six showed iso‐enhancement and 3 showed hypo‐enhancement I.n the late stage of CEUS, nine patients (9/11) showed hypo‐enhancement. Seven patients showed homogeneous enhancement S.ix patients were diagnosed as PM, three malignant, one neuroendocrine tumor and one undetermined by CEUS. Conclusions PM showed certain characteristics on CEUS. The hyper‐or iso‐enhancement at the early stage of CEUS and history of primary cancer is helpful for diagnosis of PM.

Objective To explore the expression of RIP2 in colorectal cancer(CRC)tissues,and the inva-sion and migration was observed after RIP2 was increased in CRC cell line.Methods 48 cases of CRC paraf-fin-embedded specimens and 56 cases of tumor-adjacent tissues were collected,and expressions of RIP2 was tested by immunohistochemistry(IHC).pEGFP-RIP2 plasmid and JetPRIME were employed to increase the RIP2 in SW480 cells,and variety of invasion and migration was tested in SW480 cells.Results It was showed that expressions of RIP2 was lower in CRC tumors than in tumor-adjacent tissues(P<0.05).After RIP2 in-creased,migration ability of SW480 cells weakened.Conclusion The expression of RIP2 was decreased in CRC tissues,and it was closely related to tumor cell's invasion and metastasis.

OBJECTIVE:To study the rational use of antibacterials in inpatients.METHODS:A discussion was made on the use of antibacterials for 4 948 inpatients in 2004 and 5 476 inpatients in 2005 in our hospital,managed in accordance with the requirements for hospital management by level and the Guidelines for Clinical Use of Antibacterials.RESULTS & CONCL- USIONS:The inpatient use of antibacterials in our hospital has been made basically rational through implementation of systematic management,enactment of antibacterials management by level,monitoring on usage of antibacterials and enforcement of warning system for overusing.

OBJECTIVETo investigate the risk factors of surgical site infection (SSI) in definitive surgery of intestinal fistulas.

METHODSPatients with gastrointestinal fistula undergoing definitive operation during November 2011 to November 2013 in Jinling Hospital were prospectively enrolled in the study. Risk factors of SSI were analyzed. Patients' characteristics, surgery-related data and fistula-related data were prospectively collected. Risk factors of SSI were analyzed.

RESULTSA total of 191 cases were enrolled and 51 cases developed SSI. Univariate analysis showed that patients with risk index category (RIC)≥2, length of abdominal incisions>15 cm, and duration of drainage tubes>10 days had significantly higher incidence of SSI (P<0.05). Multivariate Logistics analysis demonstrated that RIC and duration of drainage tube were independent risk factors for SSI (P=0.02, P=0.01, respectively).

CONCLUSIONSRIC≥2 and duration of drainage tubes>10 days are independent risk factors for development of SSI.

Objective To detect the expression of Beclin1 and Bcl2 in invasive pituitary adenomas and to explore the relationship of Beclin1 and Bci2 in invasive pituitary adenomas and the relativity between the 2 genes.Methods 61 specimens were classified into invasive group (32 cases) and non-invasive group (29 cases) according to the comprehensive evaluation of invasive pituitary adenomas.lmmunofluorescence analysis and RT-PCR were adopted respectively to detect the protein and mRNA expressions of Beclinl and Bcl2.The difference and relativity of Beclin1 and Bcl2 expression in invasive group and non-invasive group were analyzed.Results 32 specimens of pituitary adenoma were invasive and 29 were non-invasive.Beclin1 protein and mRNA expressions were lower in the invasive group than in the non-invasive group (P ＜0.01 ).Bcl2 protein and mRNA expressions were higher in the invasive group than in the non-invasive group (P ＜0.01 ).Pearson related analysis showed that Beclin1 mRNA expression was negtively correlated with Bcl2 mRNA expression in the invasive group ( r =-0.42,P =0.028 ).Conclusions Beclinl expression is decreased in invasive pituitary adenomas.The invasiveness of pituitary adenoma is closely related to the high expression of Bcl2 protein and mRNA,and the low expression of Beclin1 protein and mRNA.The inhibition of the autophagy may lead to the enhancement of the invasiveness of pituitary adenomas and that inhibition may come from the interaction of Beclin1 and Bcl2.

OBJECTIVETo investigate the changes in the serum content of immunoreactive calcitonin (iCT) after burns or inhalation injury, and to explore its diagnostic significance.

METHODSTwenty-four dogs were randomized into 4 groups, i. e. A (n = 6, with moderate degree inhalation injury) , B ( n = 6, with severe inhalation injury), C (n = 6, with most severe inhalation injury) and D (n = 6, with severe burns) groups. The serum content of iCT and blood gas analysis before and after injury were determined at different time points. The degree of inhalation injury was determined with fibrobronchoscopic examination at 6 post-inhalation injury hour (PIH).

RESULTS(1) Fiber bronchoscopic examination showed that the degree of inhalation injury in each group was coincident with the anticipation. (2) The serum content of iCT in each group at 1 PIH was obviously higher than that before injury, and it was evidently higher in A, B and C groups than that in D group at 4 PIH. The peak value of iCT in group A at 24 PIH was (453+/-224) ng/L, and it increased gradually in B and C groups at 48 PIH. The serum content of iCT increased continually from 2 PIH on, and it reached (125+/-41) ng/L at 48 PIH. (3) Compared with PaO2 value before injury (109+/-8) mmHg, there was no obvious difference of the PaO, in A and D groups. PaO2 value in B and C group began to descend continually at 8 PIH (65+/-6) mmHg, and that in C group began to descend at 4 PIH (71+/-9) mmHg. PaCO2 value in C group began to increase at 24 PIH(52+/-11) mmHg when compared with that before injury(38+/-5 ) mmHg.

CONCLUSIONThe changes in the serum level of iCT within 8 PIH occurred much earlier than PaO2 and PaCO2, thus it has the same diagnostic significance as fibers bronchoscopic examination.

BACKGROUND: The clinical experience of the treatment of the sternoclavicular joint dislocation and peripheral fracture is relatively lacking, but its incidence is increasing yearly. At present, there are few studies on the anatomy and biomechanics of the sternoclavicular joint in and outside China, and no systematic anatomical measurements of the sternoclavicular joint are reported. OBJECTIVE: To provide a biological reference for the clinical diagnosis and treatment of sternoclavicular joint dislocation or peripheral fractures by studying the anatomy and biomechanics of the sternoclavicular joint. METHODS: (1) A total of 16 specimens (32 sides) of adult antiseptic and moist cadaveric specimens were selected. The complete manubrium, bilateral clavicle and surrounding tissues of sternoclavicular joint were anatomically separated, and repair to bone-ligament-bone specimen models. (2) The areas of manubrium articular surface and the medial clavicular articular surface of all specimens were measured by the ink pattern combined with grid counting method. (3) The morphological features of the anterior and posterior sternoclavicular ligaments of the specimens in this group were observed, and the length, width and thickness were measured and analyzed statistically. (4) The left and right sternoclavicular joints of each specimen were randomly paired into A and B groups. Group A received simply cutting of anterior sternoclavicular ligament. Group B received simply cutting of posterior sternoclavicular ligament. Before and after cuting off the ligament, the anterior and posterior load experiments were performed on the anatomical sites with the same force arm length and perpendicular to the distal clavicle. The angles of joints and load-angle regression line slopes were compared between the two groups in the anterior and posterior directions load. RESULTS AND CONCLUSION: (1) The area of articular surface of manubrium (239.00±28.78 mm2) was smaller than the area of medial articular surface of the clavicle (482.56±44.89 mm2), and the difference was statistically significant (t=-40.105, P < 0.001). (2) The length, width and thickness of the anterior sternoclavicular ligament were (17.56±1.94 mm), (15.54±1.42 mm) and (1.93±0.32 mm), and the length, width and thickness of the posterior sternoclavicular ligament were (17.21±1.86 mm), (15.97±1.17 mm), and (2.07±0.29 mm) respectively;there was no significantly statistical difference in the length, width and thickness between them (P > 0.05). (3) Before cutting the ligaments, when the loads were 2, 4, 6, 8, and 10 N, the angle backwards of joint caused by loads in the forward direction was less than the angle of forwards of joints caused by loads in the backward direction, but only when the loads were 6, 8, and 10 N, the difference between them was statistically significant (P < 0.05). The slope of the regression line of load-angle for the loads in the forward direction was less than the slope of the regression line of load-angle for the loads in the backward direction, with statistical difference (F=31.413, P < 0.001). After the ligaments were cut, when the loads were 2, 4, 6, 8 and 10 N in the forward direction in group A and group B, the backward angulation of joint in group A was less than that in group B (P < 0.05). The slope of the load-angled regression line in group A was less than that in group B (F=52.224, P <0.001). When the loads in the backward direction in group A and group B were 2, 4, 6, 8 and 10 N, the forward angulation of joint in group A was greater than that in group B (P < 0.05), and the slope of the load-angled regression line in group A was greater than that in group B (F=12.503, P=0.008). (4) These results suggest that contact area between the articular surface of the medial clavicle and the articular surface of the manubrium is narrow, which determines the instability of the joint itself. The sternoclavicular ligament is extremely important for maintaining the joint stability. The forward angulation of joint restriction effect of sternoclavicular ligament was weaker than that of the backward angulation, also because of the joint in the anatomical position of the natural forward angulation, so the sternoclavicular joint was prone to anterior dislocation. It is necessary to pay attention to the repair and reconstruction of sternoclavicular ligament when sternoclavicular joint dislocation or peripheral fractures are treated by operations.