Objective To explore the effect of comorbidities on the surgical outcomes of elderly patients with hip fracture. Methods The Age,gender,weight,type of fracture,preoperative comorbidities and surgical outcomes of 117 patients aged 80 yr or over who undergoing hip fracture surgery in our hospital were recorded. Patients were divided into rehabilitation group and postoperative in-hospital death group ac-cording to surgical outcomes. The potential predictors of postoperative in-hospital death were identified by univariate model and were then entered into multiple Logistic regression analysis. Results Twenty three patients(19. 7%)had no comorbidity,94 patients(80. 3%)had one or more comorbidities. Ten patients(8. 5%)died in hospital after the operation. Predictors of postoperative in-hospital death were preoperative respiratory diseases and three or more comorbidities. Conclusion Surgical outcomes of elderly patients with hip fracture may be predicted by analysing preoperative comorbidities. Preoperative preparations must be sufficient in order to ensure successful operation.

Objective To explore the value of convergence symptom in predicting the treatment sensitivity and the prognosis of patients with breast infiltrating ductal carcinoma (IDC).Methods A retrospective review was performed in 46 women with 47 IDC lesions.Correlation between clinicopathological characteristics and convergence symptom was analyzed.Clinicopathological characteristics included tumor size,tumor grade,axillary lymph node state and the expression of ER,PR and H ER2.Results There was no obvious difference within different IDC groups by tumor size or axillary lymph node state in the presentation of convergence symptom (P ＞ 0.05).The convergence symptom was more common in grade Ⅱ IDC lesions than in grade Ⅲ IDC lesions and the difference was statistically significant (P =0.008).No difference was found between the presentation of convergence symptom and the expression of ER (P =0.055).Significant correlations were found between the presentation of convergence symptom and the expression of PR and HER2 (P ＜0.05).Conclusions Convergence symptom is helpful in predicting the treatment sensitivity and the prognosis of patients with breast infiltrating ductal carcinoma.

Objective To investigate the positive ratio of urine and gender difference of chronic kidney disease(CKD) with children in Lanzhou,a heavy pollution and underdeveloped city in northwest of China.Methods Through the Multistix 10 SG,the morning urine of the children were detected,which aged from 12 to 13 years old.Results The positive ratio of urine was 14.9％ in subjects,18.2％ in girls and 12.8 ％ in boys respectively.Furthermore,the positive ratio in girls showed statistically significant higher than boy's.(x2 =21.77,P ＜ 0.01).Espcially,the ratios of hematuria and pyuria significantly increased in girls (x2 =17.52,P ＜ 0.01;x2=7.95,P ＜ 0.01).Conclusion The gender difference of the positive rate of urine was existed in our large samples.And there is a higher prositive rate of hematuria and pyuria in the girls.This investigation will enrich the epidemiological data of CKD in children(12 ～ 13 years old)in Lanzhou city.

Objective To compare the application value of three different planes obtained by automated breast volume scanner for the observation of margin characteristics of breast masses.Methods Two hundred and eight women patients with 237 masses (120 benign and 1 1 7 malignant,confirmed by pathology)were included in this study.The detection rates of mass margin characteristics in three different planes were compared.The diagnostic performance of mass margin characteristics in differentiating benign and malignant breast masses in three different planes was compared by area under the ROC curve (AUC). Results The detection rate of angular margins for malignant masses in sagittal planes(41 .9%)was higher than that in coronal planes(22.2%)and axial planes(26.5%)with statistical difference (P =0.001 ,0.013);the detection rate of spiculated margins for malignant masses in coronal planes(42.7%)was higher than that in sagittal planes (1 1 .1 %)and axial planes (1 7.1 %)with statistical difference (both P < 0.001 ).No significant difference was found between any two of the three planes in the detection rates of margin characteristics for benign masses.The AUC of angular margins in sagittal planes (0.693)was higher than that in coronal planes (0.607)and axial planes (0.624);the AUC of spiculated margins in coronal planes (0.697)was higher than that in sagittal planes (0.55 1 )and axial planes (0.573 );the AUC of indistinct margins in axial planes(0.606)was higher than that in coronal planes (0.552)and sagittal planes (0.552);the AUC of microlobulated margins in axial planes (0.825)was higher than that in coronal planes (0.778) and sagittal planes (0.81 7).Conclusions Three different planes of ABVS have their own advantages for the observation of margin characteristics of breast masses.

Objective To compare features between color Doppler flow imaging(CDFI) and contrast-enhanced ultrasonography(CEUS) in the diagnosis of small renal cell carcinoma(SRCC) and investigate the diagnostic value of CEUS. Methods The images of CDFI and CEUS examination were retrospectively analyzed in forty-five SRCC (≤3 cm in diameter) which were confirmed sequentially by operation and pathology. Inner echoes,boundary,dark-ring and color flow of tumors were observed by CDFI. The degree of tumor vascularity was subjectively graded from 0 to Ⅳ. Enhancement patterns and phases on uhrasonography were reviewed, including enhancement start time, peak time, wash-out time and enhancement appearances of SRCC. Results The images were observed as homogeneous or relatively homogeneous (19) and heterogeneous or relatively heterogeneous(26), clear boundaries(37, including 10 with dark-ring) and ill-defined margins(8). The tumor vascularity was showed as grade 0(5) ,grade Ⅰ (6),grade Ⅱ (14),grade Ⅲ (14),grade Ⅳ(6) on CDFI. All lesions were showed mean enhancement start time (13.84±3.80) seconds,peak time (19.49±4.73) seconds,wash-out time (26.91±5.86) seconds respectively on CEUS. All cases were observed as simultaneous wash-in(39) and gradually wash-in(6),hyperechoic(14) and isoechoic(22) and hypoechoic(9) in peak time, simultaneous wash-out (19) and rapidly wahs-out (19) and gradually wahs-out(7). After contrast medium injection, tumors were detected partly non-enhaneement or cellular enhancement (25) and pseudocapsule (20). Conclusions CEUS is effective in improving the sonographic visualization of tumoral vascularity ,internal structure and pseudocapsule. It plays an important role in the diagnosis of SRCC.

Objective To investigate the enhancement patterns of hypervascularized breast tumors with real time contrast-enhanced ultrasound (CEUS) and to evaluate the accuracy of CEUS in comparison with power Doppler in the discrimination purpose. Methods CEUS was preoperatively performed in 35 patients with 37 hypervascular breast lesions detected on power Doppler. The patterns of enhancement were analyzed and compared with morphological characteristics of the vessels displayed by power Doppler. Results Considering initial lump enhancement and peripheral flake enhancement as a criterion suggesting malignancy, CEUS showed a sensitivity of 90.9% ,a specificity of 73.3% and an accuracy of 75.70/00. While the morphological characteristics of the vessels demonstrated by power Doppler showed no significant difference between benign and malignant lesions, Conclusions CEUS is more accurate than power Doppler ultrasound in the assessment of blood flow of hypervascular breast tumors and more helpful in the differentiation role.

Objective To explore the diagnostic value of contrast-enhanced ultrasonography (CEUS) in ureteral lesions.Methods The ultrasonogram of conventional ultrasound and CEUS were retrospectively analyzed in 19 confirmed ureteral lesions cases by operation and pathology.The size,inner echoes,boundary and color blood signal of ureteral lesions were observed by conventional ultrasound.The modality and phases of enhancement,including arrival time,peak time,washout time and appearance of internal structure,were observed by CEUS.Results The 19 ureteral tumors were of maximum widths between 2.1 to 7.7 cm.Conventional ultrasound showed 7 hypoechoic masses,10 isoechoic masses,1 hyperechoic mass and 1 unclear mass.Color Doppler flow imaging showed fairly rich blood signal in 8 tumors,a small amount of blood signal around tumor in 6 tumors and no blood signal in the rest.In early phase,CEUS showed enhancement in all 19 ureteral lesions,including synchronously enhancement in 8 tumors and delayed enhancement in 11 tumors.In peak time,hypoechogenicity compared to the normal renal cortex was shown in 3 tumors,hyperechogenicity in 11 tumors and isoechogenicity in 5 tumors.In late phase,fast wash-out was displayed in 16 tumors,isochronously wash-out in 1 tumor,delayed wash-out in 1 tumor and unclear in 1 tumor.The detection rates of blood supply and clear boundary in ureteral lesions and the diagnostic sensitivity for ureteral cancer were 74% (14/19),16% (3/19),50% (8/16) by conventional ultrasound respectively.The detection rates of blood supply and clear boundary in ureteral lesions and the diagnostic sensitivity for ureteral cancer were 100% (19/19) ,58% (11/19) ,94% (15/16) by CEUS respectively.The change of these performances was statistically significant between conventional ultrasound and CEUS.Conclusions CEUS can improve blood supply,boundary and the diagnostic sensitivity of ureteral lesions.

Objective There is little research on the relationship of gene polymorphism of CYP2C19 and clopidogrel response after percutaneous transluminal angioplasty and stenting ( PTAS) in patients with ischemic cerebrovascular disease.The study aimed to investigate the relationship between gene polymorphism and high on-treatment platelet reactivity ( HTPR ) after PTAS and 6 months of regular dual antiplatelet administration in patients. Methods A total of 145 Chinese patients treated with PTAS in our de-partment from January 2011 to March 2014 were enrolled in this study.According to the gene sequencing, patients were divided into wild-type group(CYP2C19*1/*1,69 cases) and mutation group(heterozygous mutation CYP2C19*1/*2 and homozygous mutation CYP2C19*2/*2, 76 cases).Patients received a 100mg/d aspirin and 75mg/d clopidogrel maintenance dose (MD) as dual anti-platelet therapy after PTAS.The clopidogrel inhibition effect was measured by thrombelastography ( TEG) system 6 months after PTAS. Routine cerebral artery digital subtraction angiography was applied to evaluate whether there was restenosis in stent and logistic regres-sion analysis was used to analyze the influential factors of HTPR after PTAS and clopidogrel adminstration. Results After 6 months'regular administration of clopidogrel after PTAS, the platelet adenosine diphosphate ( ADP ) receptor inhibition rates in wild-type group, heterozygous mutation and homozygous mutation group were respectively (58.43 ±21.98)%, (47.80 ±22.93)%, (37.53 ± 21.84)%.The platelet ADP receptor inhibition rate was significantly decreased compared with wild-type group(P=0.001).Carriers of at least one CYP2C19 loss-of-function ( LOF) allele had a higher frequency of clopidogrel HTPR (35.5% vs17.4 % for patients with and without LOF alleles, respectively;P=0.014) .Using multivariate logistic regression analysis, the carriage of CYP2C19 LOF alleles was an independent predictor of the post-procedure HTPR (OR=2.356, 95% CI:1.053-5.272, P=0.037).The rate of ISR was remarkably higher in patients with at least one CYP2C19*2 alleles compared with wild-type patients(11.8%vs 1.4%, P=0.019) . Conclusion In patients with ischemic cerebrovascular disease, the CYP2C19 LOF allele had significant impact on post-procedure clopidogrel HTPR and the prognosis of ISR after PTAS.

Background and objective Geiftinib and Pemetrexed are drugs used as second-line therapy for ad-vanced non-small cell lung cancer (NSCLC), although studies comparing the two drugs are limited. hTe aim of this study is to explore the effects, safety, and quality of life (QoL) of Geiftinib and Pemetrexed on patients with advanced non-squamous NSCLC. Methods Forty-six advanced non-squamous NSCLC patients who failed to ifrst-line therapy were randomly divided into two groups with 23 patients each, one using oral Geiftinib (Geiftinib group) and the other using intravenous injection Pemetrexed (Pemetrexed group). hTe effects, safety, and QoL were determined and analyzed. Results For the Pemetrexed group, objective response rate (ORR) was 13.0%(3/23), disease control rate (DCR) was 30.4%(7/23), and median progres-sion-free survival (mPFS) was 3.1 months. In the Geiftinib group, ORR was 17.3%(4/23), DCR was 39.1%(9/23), and mPFS was 4.4 months. Compared with the Pemetrexed group, the ORR, DCR, and mPFS in the Geiftinib group exhibited no statisti-cal signiifcance (P>0.05). Furthermore, the most common toxicities in the Pemetrexed group were neutropenia (n=9, 39.13%) and fatigue (n=8, 34.78%), whereas those in the in Geiftinib group were skin rash (n=8, 34.78%) and diarrhea (n=4, 17.39%). Compared with baseline, the QoL improved in both groups but to different degrees. Likewise, emotional, functional well-being, and QoL aspects speciifcally related to lung cancer were better improved in the Geiftinib group than in the Pemetrexed group (P<0.05). Conclusion hTe effects of Pemetrexed and Geiftinib as second line therapy were similar, although with dif-ferent AEs. Both drugs could improve the QoL, but Geiftinib showed better overall results than Pemetrexed.

Objective To investigate the preoperative evaluation value of multi-slice spiral CT in gastric cancer. Methods The clinical data and MSCT data of 50 cases of gastric cancer from January 2013 to January 2014 in our department for CT examination were reviewed. All patients had CT examinations before gastroscopy and other inspection data, 16 of whom underwent barium meal examination. 1 week ago, all patients underwent MSCT examination inside, and D2 radical operation for gastric cancer in 1 week. Results In 50 cases of gastric carcinoma, 10 cases of early gastric cancer, 40 cases of advanced gastric carcinoma. Thickening, abnormal enhancement and soft tissue mass for the basic features of gastric carcinoma with multi-slice spiral CT. Divided into the mass type 9 cases, localized gastric cancer 10 cases, in-filtration ulcerative type in 20 cases,diffuse infiltrative type 1 case. 20 cases of MSCT diagnosis of 50 cases of gastric cancer and 2 cases of T1 stage, 4 cases of T2 stage, 24 cases of T3 stage,20 cases of T4 stage. Among 12 cases of liver metastasis, lung metastasis in 4 cases, 3 cases of adrenal metastasis. Conclusion The application of multi-slice spiral CT scanning in patients with gastric cancer has a high reference value, it provides an important basis for clinicians to select appropriate treatment options.