Objective To study the clinical efficacy of electromyography biofeedback on dystonia after hepatolenticular degeneration.Methods 40 patients with dystonia after hepatolenticular degeneration were divided into treatment group (n=20) and control group (n=20).All patients were treated with copper-cleaning, clonazepam and benzhexol hydrochloride etc., and acupuncture. The treatment group wastreated with electromyographic biofeedback in addition. They were assessed with modified Ashworth scale, modified Barthel index, and ankledorsiflexion active range of motion. Results The lower extremities function of all patients improved after treatment (P<0.05) and thetreatment group improved more than the control group (P<0.05). Conclusion Electromyography biofeedback is more effective to improvethe lower extremities function and activity of daily living in patients with hepatolenticular degeneration following dystonia.

ObjectiveTo study the clinical efficcacy of combined therapy of acupuncture, transcutaneous electrical nerve stimulation and swallowing function training in the treatment of dysphagia for hepatolenticular degeneration.MethodsSixty patients with dysphagia for hepatolenticular degeneration were divided into three groups: group A treated with acupuncture, transcutaneous electrical nerve stimulation and swallowing function training, group B treated with acupuncture and swallowing function training, and group C treated with transcutaneous electrical nerve stimulation and swallowing function training. The three groups had all been treated for two courses of treatment(30 d).ResultsThe therapeutic effect of group A outweighed groups B and C and the socres of water swallow test and standardized bedside swallowing assessment(SSA) were higher in group A than in groups B and Cafter the first course of treatment(P＜0.01), while there were no significant difference among the three groups (P>0.05) after the second course of treatment.ConclusionCombined therapy of acupuncture, transcutaneous electrical nerve stimulation and swallowing function training is effective to improve the swallowing function of hepatolenticular degeneration following dysphagia.

Objective To summarize the clinical characteristics of primary pigmented nodular adrenocortical disease (PPNAD).Methods Eight patients with PPNAD from 2001 to 2009 in PUMC Hospital were reviewed,their clinical data were collected.Results PPNAD often occurred in adolescents.62.5% of patients with PPNAD were complicated with Carney complex(CNC).In addition to general features of Cushing's syndrome,amenorrhea and growth retardation in stature were very frequent in clinical manifestations of PPNAD.Plasma ACTH was undetectable,circadian rhythm of plasma cortisol was disappeared,glucocorticoid excretion was increased paradoxically during the dexamethasone suppression test in 50% patients with PPNAD.Adrenal imaging from 75% patients revealed normal-sized adrenal glands or suspectable micronodular changes.Adrenal pathologic analysis revealed numerous brown cortical nodules containing lipofuscin pigmentation.Unilateral adrenalectomy may relieve symptoms of Cushing's syndrome,but plasma ACTH and circadian rhythm of plasma cortisol were difficult to recovere.Hypercorticoidism might re-occure after unilateral adrenalectomy.Conclusion PPNAD should be bewared in ACTH independent Cushing's syndrome patients without apparent adrenal mass,and CNC should be screened and followed up.

Objective To investigate the role of intra-operative and percutaneous three-dimensional contrast-enhanced ultrasonic cholangiography (3D-CEUSC) in the diagnosis of biliary anomalies. Methods Diluted SonoVue, an ultrasonic contrast agent, was injected into the cystic duct of 13 living liver donors via a cannula for intra-operative 3D-CEUSC, while injection via a T tube or a PTCD tube were done in 14 patients for percutaneous 3D-CEUSC. The maximum branching order of the intra-hepatic bile ducts, the percentages of display of the first-, second-, and third-order intra-hepatic bile ducts, and the rates of detection of biliary anatomical anomalies were evaluated. Results The median of the maximum branching order of the intra-hepatic bile ducts shown was fourth-order on intraoperative 3D-CEUSC and third-order on percutaneous 3D-CEUSC, respectively. The difference was significant (P=0.01). From the first- to the third-order of intra-hepatic bile ducts, the percentages of display for intra-operative 3D-CEUSC were 100% (23/23), 96.2% (50/52) and 82.7% (86/104),respectively, while they were 100% (24/24), 94.6% (54/56) and 60. 7% (68/112) for percutaneous 3D-CEUSC. The differences were not significant when comparing the first- and the second-order branches of intra-hepatic bile ducts as shown either on intra-operative or percutaneous 3D-CEUSC (P=1).The percentages of display of the third-order branches using intra-operative 3D-CEUSC was higher than that of percutaneous 3D-CEUSC (P＜0. 0001). Three biliary anatomical anomalies were detected by intra-operative 3D-CEUSC and 4 anomalies were detected by percutaneous 3D-CEUSC. All of these anomalies were confirmed by X-ray cholangiography. Conclusion Both intra-operative and percutaneous 3D-CEUSC could diagnose biliary anatomical anomalies accurately. These procedures may become important techniques to evaluate the biliary anatomy in hepatobiliary surgery pre-operatively or intraoperatively.

Objective To investigate the value of intra-cavitary contrast enhanced ultrasound(CEUS)in the location of drainage tubes which were unclear in conventional ultrasonography. Methods The locations of 32 drainage tubes in 26 patients were unclear in conventional ultrasonography. The diluted ultrasound contrast agent (SonoVue) was injected through the tubes. CEUS was used to evaluate the visualizations of the inner tubular portions and the distal ends. Whether the drainage tubes were in situ or not was also judged. The time-consumption of detection was counted. Results The percentages of the visualization of inner tubular portions and the distal ends in conventional ultrasonography were 52.25%(18/32) and 0,respectively. However,the percentages of visualization in CEUS were 100% and 93.75%(30/32), respectively. The difference were significant when compared conventional ultrasonography with CEUS ( P＜0.001 ). CEUS detected that three drainage tubes weren't in situ. And the median of timeconsumption of CEUS was just 4. 5 seconds (range: 1-77 seconds). Conclusions Intra-cavitary CEUS is a sensitive and high efficient technique in the visualization of drainage tube which may complement the insufficiency of conventional ultrasonography. It could be used as the first choice in the location of drainage tube.

ObjectiveToexplorethedynamicchangesofoxidativestressandcytokinesinMongoliangerbilswith nonalcoholic fatty liver disease ( NAFLD) and their significance.Methods Forty-eight healthy male gerbils were randomly divided into normal group and model group , 24 in each group .Gerbils of the model group were fed with high fat diet while those of the normal group with normal diet .Eight gerbils in each group were killed at the end of 4 w, 8 w and 16 w, respectively .MDA content and SOD , GSH-PX and T-AOC activity in the liver tissue were detected by chemical method, and serum TNF-α, INF-γand IL-10 levels were determined using liquid suspension chip .Results With the development of NAFLD , MDA content in liver increased gradually , and the MDA contents were all significantly higher than those of the normal group ( P<0.01 ); T-AOC level slightly increased , and then decreased , the levels at 4 w and 16 w were markedly decreased compared with those of the normal group (P<0.05);SOD level was significantly increased and then markedly reduced, the level of the model group at 4 w was significantly increased (P<0.05), while that at 8 w and 16 w were significantly decreased (P<0.05, P<0.01).The level of GSH-PX was decreased gradually , the levels at 8 w and 16 w were significantly lower than those of the normal group (P<0.05).With the progression of NAFLD,serum TNF-αand IFN-γwere increased gradually , while the level of IL-10 decreased gradually , and the levels at 8 w and 16 w were significantly lower than those of the normal group ( P <0.05, P <0.01).Conclusions The oxidative stress-related indicators and inflammatory cytokines in the gerbil NAFLD models induced by high fat diet are significantly changed as simple fatty liver develops into steatohepatitis , liver fibrosis and cirrhosis , and participate in the development and progression of NAFLD .

Objective To investigate the feasibility of three-dimensional contrast-enhanced ultrasonic cholangiography(3D-CEUSC) in isolated porcine liver specimens.Methods The lobes of 5 isolated porcine livers were taken as scanning units and the lobular bile branches were cannulated.3D-CEUSC was performed after the administration of diluted ultrasonic contrast agents(SonoVue) through the cannula.The images were assessed in term of maximum visualization of branching orders and image quality.The coincidence of morphous was compared between 3D-CEUSC and cholangiagraphy using fluoroscopy.Results Fourteen lobular biliary branches were cannulated successfully in 5 isolated porcine livers.The maximum visualization of branching orders from the third- to first-order branches were 42.9% (6/14) ,42.9% (6/14), 14.2% (2/14) in sequence.The image quality was 21.4% (3/14) graded as well, 57.2% (8/14) as moderate, and 21.4% (3/14) as poor.Compare with cholangiagraphy using fluoroscopy, the coincidence of morphous was 42.9%(6/14) for well,42.9% (6/14) for moderate,and 14.2% (2/14) for poor.Conclusions 3D-CEUSC could be a new imaging method to evaluate the biliary anatomy.

Objective To determine the feasibility and safety of radiofrequeney(RF)ablation of entire prostate guided and monitored by contrast-enhanced transrectal ultrasound(CE-TRUS)in canine model.Methods Contrast ultrasound-guided RF ablation of entire prostate was preformed transrectally using Cool-tiptm electrodes in 7 normal canines under general anesthesia.The urethra/bladder and rectum were protected by infusion of cold distilled water through a Foley catheter and injection of cold distilled water into the prostate-rectum space,respectively.CE-TRUS findings were compared with TTC-stained pathologic results.Results All the 7 canines tolerated the ablation procedures.CE-TRUS clearly demonstrated hypoechoic thermal lesions as avascular/nonperfusion areas.The average number acquired for entire prostate ablation was 4.3(3 to 6).The average ablation volume achieved on pathology was 96.55%.There was no statistically significant difference when compared average ablative volumes between CE-TRUS and TTC-stained pathology[(9.16±5.20)cm3 vs(8.62±3.13)cm3,P=0.583].The coefficient correlation was 0.94(P=0.002).No thermal related injuries were found in anv of the bladder and rectum.The thermal related inj uries of the urethra were less than 1/4 quadrant.Conclusions It is feasible to ablate the entire prostate using RF thermal energy under CE-TRUS guidance.CE-TRUS plays a key role for achieving entire prostate ablation.The urethra and rectum can be protected by cooling of these structures during the procedure.

Objective To discuss the use of contrast enhanced intraoperative uhrasound(CE-IOUS) in evaluating hepatic radiofrequency ablation(RFA)lesions.Methods Fifteen RFA lesions in twelve dogs were examined by IOUS and CE-IOUS 15 min and 30 min after RFA.IOUS and CE-IOUS images were compared with RFA specimen stained by TTC.Results Satisfactory images could be achieved bv CE-IOUS at 15 rain after RFA.Compared with IOUS,CE IOUS could depict the border of RFA lesions more clearly (P＜0.01).In CE-IOUS,93.3%(12/13)of RFA lesion images were consistent with that of TTC in shape,while in IOUS,only 13.3%(2/15)of the images were consistent with that of TTC in shape.The average areas of RFA lesions cross-section measured by IOUS,CE-IOUS and TTC were(4.82±1.49)cm2,(3.48±1.25)cm2 and(2.93±0.87)cm2.Statistical significance was found between the areas shown by IOUS and TTC staining(P=0.000),as well as between CE-IOUS and TTC staining(P=0.027).The areas shown by IOUS and TTC were not linear correlated(r=0.28,P=0.316),but the areas shown bv CE IOUS and TTC were wetl correlated(r=0.75,P=0.002). Conclusions CE-IOUS is a promising method for evaluating intraoperative RFA lesions and worthy of further clinical research.

efore graft harvesting in living donor liver transplantation.