Objective To use the real-time shear wave elastography(SWE)to detect the elasticmodulus values of different breast lesions,and to assess its application value in differential diagnosis of benign and malignant breast lesions.Methods SWE was per-formed in 71 breast lesions from 63 pathologically confirmed patients.The maximum,minimum and mean elasticmodulus values in breast lesions were detected and the ROC curves were used to determine the optimal diagnostic cut off value.Results Among 7 1 le-sions,48 cases were benign lesions and 23 cases were malignant lesions.The diagnostic accuracy and Youden index of the ordinary ultrasound were 77.5% and 0.55 respectively.The maximum,minimum and mean elasticity values for malignant lesions were (106.7±37.9),(23.7±6.4),(44.8±6.6)kPa respectively,whereas which for benign lesions were(42.7±14.6),(17.2±6.3), (29.4±8.0)kPa respectively.The maximum,minimum and mean elastic values had statistically significant differences between be-nign and malignant lesions(P<0.05).The areas under the curve(AUC)of the maximum,minimum and mean elastic values were 0.963,0.798 and 0.914 respectively.Taking 78.1 kPa as the threshold of the maximum elasticity value,the sensitivity was 82.6%and the specificity was 95.8%.Taking 37.6 kPa as the threshold of the mean elasticity value,the sensitivity was 87.0% and the specificity was 83.3%.Conclusion SWE provides a new way for the differential diagnosis of benign and malignant breast lesions, and the maximum and mean elastic value can be used as the diagnostic evidence for differentiating benign and malignant breast le-sions.

Objective To evaluate the safety,effectiveness and clinical factors of re-intervention of transjugular intrahepatic porto-systemic shunt (TIPS).Methods A retrospective study of safety and longterm outcomes of TIPS was made in 771 patients from August 1994 to August 2010.The 625 patients had follow-up data.The patients who received TIPS once,twice,and more than twice were divided into group 1,group 2 and group 3,respectively.Clinical symptoms,survival rate and restenosis rate of each group were analyzed.Clinical influencing factors of re-intervention effect were discussed.Results The success rate of first intervention was 98.2％ (757/771),the death rate was 0.7％ (5/757) and severe complication rate was 2.5％ (19/757).The success rate of re-intervention was 98.7％ (457/463),no death and severe complications occurred.The restenosis rate in group 3 decreased significantly than group 1 ( x2 =7.908,P ＜0.05 ) in the first year of TIPS.The restenosis rates in group 2 and group 3 were lower than group 1 from 2 to 5 years of TIPS ( x2 values were 27.046,25.724,37.002 and 19.046,respectively,P ＜ 0.05 ). The survival rate in group 3 was higher than group 1 (x2 =9.114,P＜0.05)and group 2 was higher than group 1 ( x2 =4.929,P ＜ 0.05 ) in the first year of TIPS,while there was no statistical difference between group 2 and group 3 ( x2 =2.678,P ＞ 0.05).The patients in group 2 and group 3 also had higher survival rates than group 1 from 2 to 5 years of TIPS (x2 value were 41.314,26.920,13.692 and 6.713,respectively,P ＜ 0.05 ).19.4％ (79/406)of patients who received re-intervention had symptom recurrence and shunt stenosis or occlusion. 11.6％ (47/406) of patients had symptom recurrence with portal hypertension signs,62.8％ (255/406) had shunt stenosis or occlusion with portal hypertension signs.Conclusions Restenosis or occlusion of TIPS,symptom recurrence and portal hypertension signs were important factors for re-intervention.Re-intervention of TIPS was safe and effective,and could improve the survival rate of patients with TIPS.

Objective: To evaluate the efficacy of bilateral erector spinae plane block (ESPB) in improving intraoperative wake-up quality in the patients undergoing thoracolumbar scoliosis correction with general anesthesia. Methods: Forty American Society of Anesthesiologists physical status Ⅱor Ⅲ patients of both sexes, aged 18-60 yr, scheduled for elective posterior approach thoracolumbar scoliosis correction, were divided into 2 groups (n=20 each) using a random number table method: control group (C group) and bilateral ESPB group (E group). Bilateral ESPB was performed through injecting 0.375% ropivacaine 15-20 ml to each site in group E. Anesthesia was induced by intravenously injecting propofol, sufentanil and cisatracurium after dexmedetomidine was intravenously infused for 10 min.Anesthesia was maintained by intravenously infusing remifentanil, propofol and dexmedetomidine.Propofol infusion was stopped and the infusion rate of remifentanil and dexmedetomidine was decreased during intraoperative wake-up test.Wake-up test was performed every 30 s starting from 5 min after stopping propofol infusion.The wake-up time, occurrence of agitation and coughing, hemodynamic changes (△MAP and △HR, the difference between MAP while stopping administration before wake-up test and maximum MAP during wake-up test, the difference between HR while stopping administration before wake-up test and maximum HR during wake-up test) and blood loss were recorded.The wake-up quality was assessed during operation. Results: Compared with C group, the wake-up time was significantly shortened, the incidence of agitation and coughing was decreased, blood loss was reduced, △MAP and △HR were decreased, and the wake-up quality was increased in E group (P<0.05). Conclusion Bilateral ESPB can increase the intraoperative wake-up quality in the patients undergoing thoracolumbar scoliosis correction with general anesthesia.