ObjectiveTo compare the clinical effects of extracorporeal shock wave lithotripsy (ESWL) and ureteroscope holmium laser lithotripey(URL) in emergency patients with ureteral calculi.MethodsTwo hundred and forty emergency patients with ureteral calculi were retrospectively analyzed,including 110 patients undergoing ESWL (ESWL group) and 130 patients undergoing URL (URL group).Results The success rate of fragmentation and calculi-free rate were 90.0％ (117/130) and 80.8％(105/130) in URL group,of which were 88.2％(97/110) and 75.5％(83/110) in ESWL group with no significant difference between two groups (P ＞ 0.05 ).The success rate of fragmentation and calculi-free rate of upper ureter in ESWL group were much better than those in URL group[93.1％(54/58) vs.84.3％(59/70),77.6％ (45/58) vs.70.0％ (49/70),P ＜ 0.05 ],those of middle-lower ureter in URL group were much better than those in ESWL group[96.7％(58/60) vs.82.7％(43/52),93.3％(56/60) vs.73.1％(38/52),P＜0.05].ConclusionESWL and URL both have good curative effects in emergency patients with ureteral calculi,and ESWL has better effects for upper ureter while URL for middle-lower ureter.

Objective To discuss the value of color Doppler ultrasonography in the diagnosis and differential diagnosis of urinary tract urothelial carcinoma (UTUC).Methods Color Doppler ultrasonography exam was practiced in 84 UTUC patients preoperatively.According to ultrasound characteristics,lesions was classified into nodular type,wall thickening type and solid mass type,which were confirmed by pathology in all cases postoperatively.Results In the total of 84 cases (76 transitional-cell carcinoma,5 adenocarcinoma and 3 epidermoid carcinoma),lesions infiltrated laminae propria and surrounding tissue in 65 cases.In the nodular type of UTUC,there were nodules raising into lumen.Wall thickening type of UTUC was characterized by irregularly wall thickening,lumen narrowing,truncating and breaking.Similarly,obstruction broke off the ureteral lumen suddenly in solid mass type of UTUC.A clear demarcation could be found between the pipe wall and surrounding tissue in nodular type.However,such clear demarcation could not be found in wall thickening type and solid mass type.The accordance rate of ultrasonographic located diagnosis were 92.9 ％ (78/84),with 6 missed diagnosis cases.The accordance rate of qualitative diagnosis were 89.7％ (70/78).Conclusions As result of color Doppler ultrasonography,there were different relationship between lesion and the peripheral tissue in different types of UTUC.In types of wall thickening and solid mass,the demarcation was unclear and it is easier to violate the surrounding tissue.Color Doppler ultrasonography can provide more effective information for diagnosis and therapy UTUC.

Objective To restore the incisal angle defect of anterior upper teeth with partial cov-erage porcelain veneer, and evaluate the clinical performance of the restoration. Methods A total of 12 patients were included, and 14 anterior upper teeth with small incisal angle defect were involved in this study, after tooth reduction of 2 mm wider than the defect of every teeth, 14 partial coverage IPS-Empress Ⅱ veneers were made and binded with Variolink Ⅱ adhesive system. During the observation period of 36-48 months after insertion, prosthodontic results were evaluated, using the CDA quality e-valuation system, and marginal integrity, anatomic form, surface and color of the veneers, and sec-ondary caries were examined. Results During the period of 36-48 observation, all of the 14 restora-tions were rated satisfactory. Conclusions With strict control of indications, the partial coverage porcelain veneer could function satisfactorily as an alternative restoration for small incisal defect of an-terior upper teeth.

Objective To report effects of microsurgical treatment for tumors in cervical spinal canal. Methods A total of 32 cases of tumors in cervical spinal canal had received microneurosurgery through a posternmedial approach. 22 cases had received reconstruction of cervical spinal canal stability. Results A total tumor resection was performed in 26 cases (81.25%),a subtotal tumor resection was conducted in 6 cases(18.75%). A cemplete recovery was achieved in 23 cases(71.88%), an improvement of symptoms was achieved in 6 cases(18.75%), and no improvement in 3 cases(9.38%), no death was encountered. Follow up observations were carded out in 30 cases for 3 months to 3 years. MRI examinatious 3 months after operation in 26 cases found no residual or recurrent tumor,recurrence was seen in 3cases of astrocytoma, 1 case was invariable. X-ray radiography in 26 cases showed good vertebral stability ,spinal deformation was found in 4 eases. Conclusion Microsurgery in early period play a key role in treatment of cervical spinal tumors. Reconstruction of spinal canal stability is important to patients.

Objective To investigate the feasibility of treatment mode of end-to-end anastomosis of esophagus(EAS) af ter partial resection for early-stage cervical esophageal carcinoma(ECEA).Methods 7 patients were substantially confirmed as squsmous cell carcinoma of cervical esophagus by endoscopy,the nearest distance of the lesion from the incisors was 17cm,and the furthest was 20 cm,the maximum extent was 2.5 cm,and the minimum was 1 cm.None of them with longitudinal muscularis invasion.Confirmed by PET/CT or chest enhancement CT examination preoperatively,intrathoracic and cervical lymphatic metastasis was excluded,cT1 -2 N0 M0.Incisal margin length was not less than 1 cm,the maximum was 5 cm and the minimum was 3 cm.Meanwhile,the cervical lymph node should be dissected,and the average number was 6.43 per case.After surgery,all the patients were fixed by plaster slab to release the tension of anastomosis.Postoperative adjuvant radiotherapy or chemotherapy was received.Results None of the patients had severe postoperative complications,and the average hospital stay was 14.5 days.All the patients are alive,the longest follow-up lasts for 3 years and 4 months,all of them can take normal food,without anastomotic stenosis.Conclusion Treatment mode of EAS after partial resection for ECEA significantly decrease the operative damage,apparently improve the patient's quality of life(QOL),so that the patients can better receive adjuvant treatment subsequently; it is a feasible and effective method for cervical esophageal carcinoma at the early stage.

ObjectiveTo probe the value of transrectum ultrasound (TRUS) in evaluating the effect of new adjuvant therapy (NAT) in treating middle-low level rectal cancer (MLLRC).MethodsTRUS was used to examine 82 cases of MLLRC before and after NAT.All cases were pathologically confirmed.The results of TRUS before and after NAT were compared.ResultsThe diagnostic rate of TRUS in MLLRC was 97.6％(80/82).The up to down range and thickness of foci of 80 cases which were detected by TRUS before NAT showed different degree diminution after NAT( P ＜0.05).The number of lymph node around rectum decreased obviously ( P ＜0.05).Only the lymph nodes of 5 cases of all lymph nodes detected by TRUS before and after NAT showed dot flow signal.ConclusionsTRUS can clearly showed the MLLRC foci,internal flow signal and lymph nodes around rectum.This is of important value in evaluating the effect of NAT,choosing the therapeutic schedule and avoiding over therapy.

Objective To probe the clinical diagnosis value of high frequency ultrasonography (HFUS) in thyroglossal duct cyst(TDC). Methods Forty-one TDC were taken HFUS and the location, boundary,shape,interal echo of lesions and the relation to hyoid bone were observed. The periphery and internal blood flow signal were detected by color Doppler flow imaging. The results of HFUS were compared with those of pathology after operation. The cases were divided into groups according to pathological types and were compared with acoustic image shows. Results All cases were diagnosed TDC by pathology after operation. Internal walls of 9 TDC consist of cilium columnar epithelium, 19 consist of stratified pavement epithelium and 13 consist of this two epitheliums. HFUS showed different pathological types had different ultrasonic appearances. In this study, 77.8%(7/9) TDC with columnar epithelium showed echoless,84.2 (16/19) TDC with pavement epithelium showed similar solid echopattern and TDC with two epitheliums mainly showed similar solid echopattern and multi-room cyst. Hyperechogenicity of hyoid bone displayed around the lesion in 80.5%(33/41)TDC. No blood flow signal showed in 41 TDC and a little punctiform blood flow signal showed in the periphery of 5 TDC. The diagnose accordance rate of HFUS in TDC was 95.1%(39/41). Conclusions HFUS can clearly show the location, boundary, shape,interal echo of TDC and its relation to hyoid bone. HFUS is important for diagnosis and differential diagnosis of TDC.

Objective To probe the value of color Doppler ultrasonography (CDU) in differential diagnosis of the pure mucinous adenocarcinoma of breast (PMAB) and adenofibroma of breast (AFB).Methods Twenty-five cases of PMAB and 30 cases AFB were examined by CDU. The sonographic appearance, interior and peripheral blood flow distribution and Doppler frequency of the tumors were observed and analyzed. The results of the diagnoses of CDU and the pathologies were compared. Results The diagnostic rates of PMAB and AFB by CDU were 76.0% and 93.3%, respectively. The clear peplos was observed in 90% of AFB, and internal even echoes. Yet no peplos was observed in PMAB, and the internal echoes of most PMAB were confused and disordered. The detection rate of Ⅰ ～ Ⅱ stage blood flow in adenofibroma of breast was only 40% and that of Ⅰ ～ Ⅲ stage blood flow in PMAB was high to 76%.The detection rate of blood flow stage and the resistant index (RI) of the blood flow frequency spectrum of PMAB and AFB were significantly different. Conclusions CDU has significant clinical value in differential diagnosis of pure mucinous adenocarcinoma and adenofibroma of breast.

Objective To probe the differential diagnostic value of color Doppler ultrasonography(CDU)in cystitis glandularis.Methods Thirty-nine cystitis glandularis and 192 bladder cancer were examined with CDU.The location,shape,boundary,internal echo and relationship with wall of urinary bladder of lesion were observed.Internal blood flow disposition of lesion were detection.The results of CDU were compared with those of cistoscope biopsy and pathologic diagnosis after operation.Results 59.0%(23/39)cystitis glandularis and 52.9%(74/140)bladder cancer lesions located in trigone of bladder and surrounded the orifice of ureter.53.8%(21/39)cystitis glandularis showed part wall thickening and 72.9%(140/192)bladder cancer showed single nodus or bolus.Sacculiform anechoic area were observed in 69.2%(27/39)cystitis glandularis and were not observed in bladder cancer.Punctiform hyperechogenicity appeared in periphery of 48.4%(93/192)bladder cancer and 7.7%(3/39)cystitis glandularis.The detection rate of interior blood flow signal of bladder cancer was 84.9%(163/1 92),which was obviously higher than that of cystitis glandularis.The diagnostic accurate rates of CDU in cystitis glandularis and bladder cancer were 84.6%(33/39)and 95.3%(183/192),respectively.Conclusions CDU can clear display the location,shape,boundary,internal echo and relationship with wall of urinary bladder of cystitis glandularis and is of important value in diagnosis,differential diagnosis and clinical fllow-up of cystitis glandularis.

OBJECTIVETo systematically review the clinical efficacy of acupuncture on the patients with low back pain (LBP).

METHODSRandomized controlled trials (RCTs) about pure acupuncture therapy versus other treatments in treating LBP were electronically searched in PubMed, CBM, EMbase, The Cochrane Library, CNKI, VIP and Wanfang Data from January 2004 to May 2014. The observed index on the results were the changed scores of VAS, ODI, JOA and RMDQ. Two reviewers independently screened the literatures according to the inclusion and exclusion criteria, as well as the extracted data, and assessed the methodological quality. The results of Meta-analysis was conducted by RevMan 5.2 software.

RESULTSTen RCTs involved 751 patients were finally included. The results of Meta-analysis indicated that the role of pure acupuncture group in improving the VAS score was better than that of the control group, and the combined effect size was RR = -.32, 95% CI (-1.41, -1.22); Z=27.28, P<0.00001; the role of pure acupuncture group in improving the ODI score was better than that of the control group, and the combined effect size was RR = -5.07, 95% CI (-7.50, -2.65); Z=4.10, P<0.0001; the role of pure acupuncture group on improved JOA score was better than that of the control group and the combined effect size was RR=2.83, 95% CI (2.02, 3.63), Z=6.90, P<0.00001. The role of pure acupuncture group in improving the RMDQ score was better than that of the control group, and the combined effect size was RR = -2.80, 95% CI (-3.49, -2.11), Z=7.95, P<0.00001.

CONCLUSIONThe result of meta-analysis demonstrates that pure acupuncture may have a favorable effect on self-reported pain and functional limitations in LBP patients.