Objective To explore the influence of ROI size on the diagnostic performance of shear wave elstography (SWE) of breast masses.Methods A total of 225 consecutive patients with 239 solid breast masses underwent SWE before surgery,and then quantitative SWE parameters,including the maximum stiffness (Emax),mean stiffness (Emean),ratio of stiffness of the mass to stiffness of surrounding fat (Eratio) and standard deviation (SD),were measured by two methods,one method was using larger ROI to include the largest part of a mass,and the other was placing fixed ROI=2 mm over the stiffest part of the lesion to measure.The diagnostic performance of the two methods were evaluated by ROC curve,and the cut-off value,sensitivity and specificity of each SWE parameter were obtained.Results There were no statistically significant differences between the performance of Emax,Emean and SD from the two different methods (all P＞ 0.05),the performance of Eratio of the two methods showed significant difference (P=0.046).The significantly higher specificity of Emax and Emean in the larger ROI were found,and the significantly higher sensitivity of SD and Eratio in the ROI=2 mm was found.Furthermore,the diagnostic performance of combination of SWE and BI-RADS were not greatly affected by the ROI size,the difference had no statistical significance (all P＞0.05).Conclusion The ROI size only affects the diagnostic performance of Eratio,and donot affect the diagnostic performance of the quantitative SWE parameters (Emax,Emean,SD) and combination of SWE and BI-RADS.

We have reformed our patterns and methods of graduation examination of the medical majors. That is the multi-stage comprehensive graduation examination of the clinical interns, which consists of 70% close written test of clinical theories,20% practical test of clinical skills and also oral test of related theories, and 10% writing of the medical documents. It has proved that these measures have improved the interns' attitude toward practice, aroused their initiative and positivity, and led the practitioners to attach more importance to the combination of clinical practice and theories, thus leading to better clinical education.

[Objective]To investigate the relationship of baseline antimullerian hormone(AMH)and live birth rate of IVF/ICSI and further explore the prognostic effect of AMH on live birth rate.[Methods]All non-polycystic ovary patients who underwent their first embryo transfers in our unit and had basal serum AMH evaluated between 2010 and 2015 were evaluated in this retrospective study. Patients were grouped according to their AMH level,i.e. low AMH group with AMH less than 1.1 ng/mL(n = 485),middle AMH group with AMH between 1.1 ng/mL and 7.0 ng/mL (n = 1 989),and high AMH group with AMH higher than 7.0 ng/mL (n=468). For age subgroup analysis,patients were stratified as follow:group A(age≤29 years),group B(30~34 years),group C(35~39 years)and group D(over 40 years). We compared clinical outcomes between AMH groups in different age groups usingunivariate and multivariate analysis. ROC analysis was utilized to assess predictive value of AMH on live birth rate.[Results](1)In both fresh and frozen embryo transfers,baseline AMH was significantly related to clinical outcomes. The lower AMH was,the lower implantation rate,clinical pregnancy rate,and live birth rate. However,higher miscarriage rate was observed. All difference reached statistically significant.(2)In age subgroup analysis,we demonstrated AMH was related to live birth rate in patients in group A,B, and C,regardless of fresh or frozen embryo transferred. In those over 40 years,AMH was related to live birth rate in frozen cycles (P < 0.05)but not fresh cycles(P = 0.092). The further multivariate analysis confirmed the above results after controlling po?tential confounding variables.(3)The AUC of ROC analysis for AMH predicting live birth rate were 0.647,0.633 for fresh and fro?zen cycles respectively.[Conclusion]Baseline AMH as one of excellent ovarian reserve markers ,was significantly related to live birth rate in fresh or frozen cycles. Baseline AMH was an independent prognostic factor of live birth rate,but its predictive value on live birth rate was of limited clinical value.

Objective:A study was conducted to investigate the effect of Prunella vulgaris sulfated polysaccharide (PVSP) on the expression of angiogenic growth factors (bFGF, VEGF, and IL-8) and angiogenesis in hepatocellular carcinoma. Methods:ELISA as-say was used to observe the effects of PVSP and the negative control drug Lentinan (LNT, non-sulfate radical drug) on secretions of the angiogenic growth factors, namely, bFGF, VEGF, and IL-8, in HepG2 cells in vitro. In an in vivo experiment, the microvessel density in hepatocellular carcinoma tissue sections treated with PVSP and LNT was calculated, analyzed, and compared with the microvessel den-sity in the phosphate-buffered saline (PBS) control. Results:Compared with the PBS control group, PVSP at 200μg/mL inhibited bF-GF secretion (P<0.01), whereas LNT failed to affect bFGF secretion. Neither PVSP nor LNT affected the secretions of VEGF and IL-8. In vivo results showed that PVSP at 200 mg/kg reduced the microvessel density in tumor tissue sections (P=0.03), whereas LNT at 10 mg/kg failed to affect microvessel density. Conclusion:Inhibition of bFGF secretion is a probable mechanism underlying the preven-tive effect of PVSP on hepatocellular carcinoma angiogenesis.

Objective To compare the functional and radiographic outcomes of modified dual plating and less invasive stabilization system(LISS)in treatment of patients with complex tibial plateau fractures.Methods From November 2003 to November 2004,84 patients with complex tibial plateau fracture were treated with modified dual plating or LISS fixation.Their functional and radiographic outcomes were reviewed to compare the differences in bone union time,full weight-bearing time,knee joint's HSS(The Hospital for Special Surgery)scores,complications, tibia plateau angle(TPA)and posterior slope angle(PA).Results The 84 cases had complete follow-up records and a mean tollow-up of 16.2 months(range,12 to 23 months).Nine complications occurred in the modified dual plating group.The mean full weight-bearing time and radiographic bone union time were 16.8 and 15.1 weeks respectively for this group which had a mean HSS score of 87.4 points.Six complications were found in the LISS group.The mean full weight-bearing time and radiographic bone union time were 14.1 and 13.8 weeks respectively for this group which had a mean HSS score of 89.6 points.There were no significant differences between the two groups in changes of TPA and PA.Conclusion LISS can provide as good fixation as modified dual plating can for most complex tibial plateau fractures,but additional medial plate fixation may be necessary for some special cases.

ABSTRACT:Objective To observe the structural changes of dentin irradiated with Nd:YAG laser under dif-ferent parameters and the changes of calcium-phosphorus ration,and evaluate the optimal parameters of Nd:YAG laser in treating dentin hypersensitivity (DH).Methods The model of dentin hypersensitivity was established by acid etching method.Samples were irradiated with Nd:YAG laser under different parameters.The morphological alterations of the dentin surfaces and Ca-P ratio were examined with scanning electron microscopy (SEM)combined with energy dispersive X-ray microanalysis.Results Compared with those in the control group,dentinal tubules could be blocked partially or totally with no cracks in A-C (30 mj,5 Hz),(30 mj,10 Hz)and (50 mj,5 Hz)groups. Dentinal tubules could be entirely blocked but with cracks in D (50 mj,10 Hz)and E (80 mj,5 Hz)groups.Dentin was carbonized in F (80 mj,10 Hz)group.Compared with that in the control group,Ca-P ratio was decreased sig-nificantly (P <0.05).Conclusion The suitable energy parameter of Nd:YAG laser in treating dentin hypersensi-tivity is (30 mj,10 Hz)and (50 mj,5 Hz).

Objective To evaluate the application of high-resolution ultrasonography in the diagnosis of nerve root lesion of cervical vertebra intervertebral foramen part. Methods Twenty-seven patients with root avulsion injury of brachial plexus intervertebral part and 8 patients with schwannoma of brachial plexus root were examined with high-resolution ultrasonography. Thirty healthy volunteers were involved for the sonographic imagings of normal brachial plexus intervertebral part. The ultrasound findings of the patients before operation were compared with surgical outcomes. Results The normal intervertebral part of brachial plexus were shown as hypoechoic tubular strucuture, which could be identified with cervical artery and transverse process used as landmarks for the intervertebral part of brachial plexus root. The detection ratios of normal intervertebral part for C5-C8 and outside part of braehial plexus were 100％. In 27 patients with root avulsion injury of intervertebral brachial plexus, the intervertebral nerve root were enlarged as hypoechoic area, with nerve dissected partly or disappearing, distal nerve parts outside the intervertebral foramen swelling, edema,or cerebrospinal fluid assembling as cystic masses. In 8 patients with schwannoma of brachial plexus root part, the spinal ganglia outside intervertebral foramen were shown as tumor-like hypoechoic mass, with blood supply shown inside. Conclusions High-resolution ultrasonography is of great value for early and convenient diagnosis of root avulsion injury and mass of brachial plexus intervertebral part, especially in community hospitals,which could provide important information for clinical therapy.

Objective To investigate the preventive effect of the artificial nerve canal on irritating neuralgia after neurilemmoma resection.Methods Thirty patients diagnosed as neurilemmoma were divided into artificial nerve group and control group at randomly.There were 15 patients in each group.The nerves in artificial nerve group were enclosed using the artificial nerve besides neurilemmoma resection.The nerves in control group only had neurilemmoma resection.All patients were assessed with VAS for the degree of irritating neuralgia at 3 time points after operation.Calculate the incidence of irritating neuralgia and analyze the data using statistical methods.Results In control group,the VAS scores were 7.5,5.1,2.8,and the incidences of irritating neuralgia were 80％,67％,40％,respectively.In artificial nerve group,the VAS scores were 3.2,1.5,0,and the incidences of irritating neuralgia were 33％,13％,0.The VAS scores and the incidences of irritating neuralgia of two groups had significant difference by statistical analysis (P ＜ 0.05).Conclusion The artificial nerve canal can relieve the degree and decrease the incidence of irritating neuralgia after neurilemmoma resection,which is a useful method to prevent irritating neuralgia in clinic.

Objective To study the effects of.breathing booster training and aerosol inhalation with terbutaline and ambroxol on pulmonary function in postoperative lung cancer patients. Methods A total of 84 patients requiring resection operations for lung cancer were randomly divided into treatment and control groups.In the peri-operative period,breathing booster training and terbutaline and ambroxol aerosol inhalation were given to the treatment group,while only aerosol inhalation was given to the control group.Therapeutic effects were evaluated according to patients pulmonary function and postoperative complications 2 weeks and 1 day before the operation,and again 2 weeks after the operation.Postoperative quality of life (QOL) was evaluated with St.George's respiratory questionnaire (SGRQ) 1 month after the operation. Results There was no statistically significant difference in average pulmonary function between the two groups 2 weeks before the operation.Two weeks after the operation,pulmonary function had decreased in both groups,but it was significantly better in the treatment group than in the control group.The treatment group also had significantly fewer pulmonary complications.The QOL of patients in the treatment group had improved significantly 1 month after the operation. Conclusion Breathing booster training and inhalation of terbutaline and ambroxol aerosol during the peri-operative period can significantly improve pulmonary function,reduce respiratory complications and improve the QOL of patients requiring lung cancer resection operations.This is most important for promoting their early recovery.

Objective To analyze sonographic imagings of traumatic neuromas of peripheral nerves,and to investigate the applied values of uhrasonography in the traumatic neuroma of peripheral nerve. Methods The sonographic imagings of 38 patients who had evidences of traumatic neuromas in peripheral nerves were retrospectively reviewed by the last diagnostic results of operations. Results Among 38 cases, 2 incomplete traumatic neuromas were not detected, and 1 incomplete traumatic neuroma was misdiagnosised as neurilemoma by ultrasonography. The coincidence of uitrasonography in incomplete traumatic neuroma and complete severed neuroma was 82.4% and 100%. With regard to the echogenicity of 38 traumatic neuromas of peripheral nerves, the sonographic characteristics of neuromas were all hypoechoic. Thirty-three neuromas appearanced like shuttles and 5 neuromas appearaneed like humps. Conclusions The traumatic neuroma has distinctive ultrasonic appearance. Ultrasonography is useful to direct the diagnosis and treatment of traumatic neuroma.