Objective:To study percutaneous transhepatic gallbladder drainage(PTGD) under color Doppler ultrasound in critically ill patients with acute calculus cholecystitis.Methods:A paracentetic needl was stuck into the cholecyst after going straight through 1.5-2.5 cm hepar under color Doppler ultrasound.The operator took out the bullet core,put in a guide wire,extracted the needl,inserted a central venous catheter along the guide wire,and then drew out the bile and clusised the cholecyst with metronidazole until the extracted fluid was clear and bright.Results:PTGD immediately relieved the pain in the of upper right quadrant in all the patients.Body temperature and WBC descended obviously 24 hours and returned to normal 5 days after the operation. Conclusion:Color Doppler ultrasound guided PTGD,easy to perform and with few complications and high suness rate,is an returned effective and reliable procedure for critically ill patients who are intolerant of cholecystectomy or for whom the operation is difficult to perform.

Arterial stenosis-induced hemodynamic changes and their evaluation have long been studied by lots of scholars by in vivo and in vitro experiments,clinical observation and improved experimental devices and methods,which has contributed a lot to the diagnosis and treatment of arterial stenosis.This review describes the current research results.

Objective To evaluate the sensitivity of patient-specific volumetric-modulated arc therapy (VMAT) quality assurance (QA) to minor multileaf collimator (M LC) positioning errors.Methods Systematic multileaf collimator (MLC) positioning errors (+0.5 mm,+ 1 mm and +2 mm) were introduced into the clinical VMAT patient plans with 2 types of MLC positioning errors:systematic MLC gap width errors and systematic MLC shift errors for 6 cases,including 3 cases with prostatic cancer and 3 cases with nasopharyngeal cancer.The planar dose distributions of the original and modified plans were measured using ArcCheck array.The coincidence between the measured results and the calculated results was evaluated using both absolute distance-to-agreement (AD-DTA) analysis with 3％/3 mm and 2％/2 mm criteria.Results The average passing rate of the 6 original VMAT plans was 96.0％ with the ADDTA criteria of 3％/3 mm which was commonly adopted in clinical practice.For the MLC gap width errors of + 1 mm,+2 mm,and-2 mm and the MLC shift errors of 2 mm,the drop levels in average passing rate with the AD-DTA criteria of 3％/3 mm were 8.8％,15.5％,6.1％ and 7.9％,respectively.The + 2 mm MLC positioning errors and + 1 mm MLC gap width errors could be detected by the patient-specific VMAT QA procedure.The AD-DTA criteria of 2％/2 mm was more sensitive compared with the criteria of 3％/3 mm.Conclusions Patient-specific VMAT QA is not sensitive enough to detect the systematic MLC positioning errors within 1 mm.Additional MLC QA is needed to guarantee the accuracy of VMAT delivery.

The morbidity of diabetes has been increasing rapidly in recent years. Delayed wound healing has become a common complication in diabetes, which seriously affects the orthobiosis of patients. Exploring and finding the molecular mechanisms of diabetic wound healing and the effective therapies to promote wound healing have important clinical significances. Stem cells transplant has become a research hotspot in accelerating diabetic wound healing. This article reviewed the present approaches concerning stem cells transplant in diabetic wound healing both at domestic and abroad, and looked forward the clinical therapy of stem cells on diabetic wound healing.

Objective: To observe the haemodynamic changes within ovarian stromal blood flow in patients with polycystic ovary syndrome(PCOS). Methods: 41 patients with PCOS and 10 ovulatory women underwent transrectal ultrasound associated with Doppler flow measurement of the artery within ovarian stroma during the early follicular phase (days 2-5 of the menstrual cycle) or any day in patients with amenorrhea . Results:The peculiar vascular pattern wich one prominent blood vessel showed passing through the ovarian stroma from ovary gate. This sign was observed in all ovaries in patients with PCOS.There was no significiant difference in Vmax、PI、RI between left and right ovary.The Vmax,PI,RI of the right ovarian stromal artery were (18.99?3.12)cm/s, 0.74?0.12, 0.50?0.03 respectively. The indices of the left ovarian stromal artery were (18.76?3.23)cm/s, 0.75?0.11, 0.49?0.04 respectively. Conclusion: Vascularization of the ovarian stroma is prominent in patients with PCOS than in the control. The decreased vascular resistance to ovarian stromal perfusion in patients with PCOS may lead to perfusion increasment. TRS can be used as a non-invasive, convenient, and sensitive method for assessing the blood flow within the ovarian stroma.

Objective To study the common femoral artery haemodynamics caused by different degrees of abdominal aorta extremity stenosis.Methods The lateral walls of abdominal aorta extremity were pinched with vascular clamp resulting in 1/3,1/2,2/3,3/4 stenosis by turns in 6 juvenile susscrota domesticas.The parameters of peak systolic velocity(PSV),minimum diastolic velocity(MDV),PSV/MDV(S/D)and MDV/PSV(D/S)of common femoral artery were obtained and their correlations with degrees of abdominal aorta extremity stenosis were confirmed by statistical analysis.Results The backwardware vanished or turned to forwardware when stenosis achieved certain degree.PSV had significant negative correlation with stenosis degree(R=0.985,R2=0.969),but D/S had significant positive correlation with stenosis degree when stenosis degree exceed 1/3(R=0.918,R2=0.843).Conclusions It can be concluded there is proximal stenosis disease and change of distal effective circulating blood volume according to the Doppler velocity tracing analysis.PSV and D/S are valuable parameters,however waveform should be ignored.

Objective To investigate the value of the diagnosis of contrast-enhanced ultrasound(CEUS) in renal tumors. Methods Nineteen patients with hyperechoic renal tumors detected by CEUS underwent resection for suspected renal malignant and benign tumors. The characterization of hyperechoic renal tumors on CEUS was evaluated. Results Histopathologic results of resected lesions showed benign tumors in 11 patients with angiomyolipoma and malignancy in 8 patients with clear cell carcinoma. Six patients with angiomyolipoma showed rapid wash in contrast enhancement and slow wash out on all tumor and focal tumor (6/11). One patient with angiomyolipoma was observed in rapid wash in and wash out (1/11). Four patients with angiomyolipoma showed rapid wash in and negative contrast enhancement after rapid wash out(negative contrast enhancement compared to renal cortex,4/11). Five patients with clear cell carcinoma showed rapid wash in and wash out (5/8). Two patients with clear cell carcinoma showed rapid wash in and delayed wash out (2/8). One patient with showed no enhancement on CEUS (1/8). The pseudocapsule could be seen at 5 patients with clear cell carcinoma. Wash in enhancement and wash out on clear cell carcinoma were significant in comparison to these of angiomyolipoma (P<0.05). Wash in enhancement,delayed wash out and negative contrast enhancement were no significant between clear cell carcinoma and angiomyolipoma (P>0.05). Conclusions CEUS is useful for discriminating between benign and malignant renal tumor.

Objective To study the formations of several ridges in peripheral artery velocity tracing. Methods The experimental models of constrainting limb and adrenaline were performed in 6 juvenile susscrota domesticas,tbe variations of the external lilac artery velocity tracing observed,and the parameters of peak systolic velocity (PSV), minimum post-systolic velocity (MPV), peak diastolic velocity(PDV) and end diastolic velocity(EDV) were obtained. Results With the increase of downstream circulation resistance, systolic waveshape inclined to acumination, MPV gradually degraded to zero and negatively increased subsequently, diastolic wave amplitude lowered, and EDV gradually decreased to zero. The stronger vasoconstriction was, the more striking the variations were. Conclusions Cardiac ejection forms systolic dominant wave, post-systolic backward ware is the result of backstreaming because of elastic recoil of downstream artery,and diastolic forward ware is the result of blood transient acceleration caused by elastic recoil of upstream artery. Systemic vascular resistance has significant effect on diastolic waveshape,and the occurrence of post-systolic backward ware implies downstream circulation resistance obviously increases.

Objective To study the haemodynamics changes in the proximal upstream artery caused by different degrees of abdominal aorta extremity stenosis.Methods The lateral walls of the abdominal aorta extremity were pinched with the vascular clamp to achieve 1/4,1/2 and 3/4 stenosis or occlusion in 6 juvenile susscrota domesticas,the velocity tracing of the proximal artery recorded,and the parameters of the peak systolic velocity(PSV)and minimum diastolic velocity(MDV)were obtained and statistically analyzed for their correlation with different degrees of abdominal aorta extremity stenosis.Results The diastolic velocity tracing vanished when stenosis reached a certain degree,the needle ridge and low amplitude diastolic velocity tracing emerged when stenosis to a certain extent,and only the needle ridge was present when the abdominal aorta extremity was completely obstructed.PSV reduced with the aggravation of stenosis.Conclusions The proximal upstream artery systolic ridge caused by abdominal aorta extremity stenosis tends to be acUminate,which indicates serious stenosis of the downstream artery.The systolic needle ridge and the absence of diastolic velocity tracing would suggest a complete obstruction of the blood stream in the downstream lumina.

Objective To explore a desirable therapeutic regimen,which is effective,reasonable and practicable for locally advanced nasopharyngeal cancer (LA-NPC) patients in the era of IMRT,with a potential of translating into survival improvement of these patients.Methods Patients presented with stage Ⅲ-Ⅳ B,WHO type Ⅱ or Ⅲ NPC were randomly assigned to receive concurrent chemoradiotherapy (CCRT group) (45 cases) or induction chemotherapy plus radiotherapy alone (IC + RT group) (43 cases),with random number table.IMRT and rapid arc planning were generated in the same treatment planning system for all patients.These two arms received docetaxel plus cisplatin for first cycle of chemotherapy,and cisplatin only for the second cycle.Results Forty-five patients received CCRT and 43 received IC + RT.All the patients completed two cycles chemotherapy.Compared to the CCRT group,the incidence rate of grade 2-4 leukopenia was lower in IC + RT group[67.4 ％ (29/43) vs.86.7 ％ (39/45),x2 =4.628,P =0.031],while the incidence rate of dermatitis,mucositis,neutropenia and fungal infection of oral cavity had no significant differences (all P ＞ 0.05).The tumor response rate (95.3 ％ vs.100.0 ％,P =0.236),2-year overall survival rate (95.5 ％ vs.94.2 ％,P =0.627),2-year progression free survival rate (94.6 ％ vs.88.6 ％,P =0.303),2-year local recurrent free survival rate (97.3 ％ vs.95.5 ％,P =0.951),2-year regional recurrent free survival rate (94.7 ％ vs.96.2 ％,P =0.949),and 2-years distant metastasis free survival rate (93.7 ％ vs.91.5 ％,P =0.454) of the two groups were similar while comparing CCRT to IC + RT group.Conclusion Combined IMRT with TP/DDP regimen,the efficacy of IC + RT is similar to CCRT for LA-NPC.The IC + RT group has less severe leukopenia than CCRT group,which is worth further study.