Objective To summarize the therapeutic effect of minimally invasive percutaneous plate esteosynthesis (M1PPO) with less invasive stabilization system (LISS) in distal femoral fractures. Method Twenty-eight patients with LISS in distal femoral fractures between June 2004 and May 2005 were analyzed retrospectively. Results The average following up period was ( 17.6 ± 0.1 )months (6-30 months) all 28 cases,only one case of delayed union,the others were no complications. According to Johner-Wruh score standard,28 cases were excellent 16,good 9,fair 2 and poor 1,the rate of excellent and good was 89.3%. Conclusion The therapeutic effect of MIPPO with LISS in distal femoral fractures is satisfactory.

Objective To explore the application value of dynamic vascular patterns(DVP) curve and parameter figure in the focal liver lesions by contrast-enhanced ultrasound(CEUS).Methods 83 cases of focal liver lesions diagnosed by pathologically or clinically that had undergone CEUS were analyzed by SonoLiver software.Then DVP parametric images were constructed and the time-intensity curve (TIC) parameters were calculated by TIC and DVP curve.Results Rise time(RT),time to peak(TTP),maximum intensity(IMAX),mean transit (mTT),slope of rise,and the absolute value for slope of half down between malignant and benign lesions groups indicated statistically significant difference (P ＜0.05).94.9％ of type Ⅰ was malignant lesions and 100％ Ⅳ type was benign lesions.The four types of DVP curve(Ⅰ,Ⅱ,Ⅲ,Ⅳ)in malignant and benign lesions were 72.5％,13.7％,13.7％,0 and 6.2％,43.8％,31.2％,18.8％,respectively.The proportion and characteristic of DVP parametric images and DVP curves in malignant and benign lesions groups were consistent.Conclusions DVP curve and parametric images of CEUS can demonstrate the difference of flow perfusion static between lesions area and surrounding liver parenchyma dynamically and directly.These are new qualitative indexes of the differential diagnosis in focal liver lesions.

Background Orbital tumor has complex histological types and it is difficult for clinical differential diagnosis.Therefore, it is badly in need of a new diagnostic technology to distinguish its benign and malignancy.Objective This study aimed to analyze and compare the characteristics of contrast ultrasound image between benign and malignant orbital neoplasms and evaluate the diagnostic value of contrast ultrasound to orbital tumor.Methods The clinical data of 24 patients with malignant orbital neoplasms and 51 patients with benign orbital neoplasms were retrospectively analyzed in Taihe Hospital of Hubei University of Medicine from September 2010 to September 2013.Contrast ultrasound examination was carried out on all the patients using MyLab Twice color ultrasonic device under the informed consent.SonoVue solution of 2.0 ml was intravenously injected and then the state and dynamic graphs of orbital tumors were collected.According to the classification of enhanced levels and patterns,the imaging features of orbital neoplasms were evaluated, and time-intensity curve (TIC) and dynamic vascular pattern (DVP) curve were obtained with SonoLiver software.The general ultrasonic signs and contrast ultrasonic characteristics between benign and malignant neoplasms were compared.Results Hyper-enhanced lesions were found in 62.5％ (15/24) and 27.5％ (14/51) ,and iso-intensity lesions were found in 20.8％ (5/24) and 49.0％(25/51) in the malignant orbital neoplasm patients and benign ones, respectively, with a significant difference in enhanced types between them (x2 =26.40,P＜0.01).Based on the enhanced mode, heterogeneity enhancement lesions were found in 75.0％ (18/24) and 25.5％ (13/51), and hemogeneity enhancement lesions were seen in 25.0％(6/24) and 47.1％ (24/51) in the malignant orbital neoplasm patients and benign ones, respectively, showing a significant differnee between them (x2 =30.40, P ＜ 0.01).The 58.3％ patients showed rapid rising and sharp descending TIC curves,and 75.0％ patients showed the biphasic wave DVP curves in the malignant lesions;while in the benign lesions,the TIC curves of 78.7％ patients were quick lift and slow dessend, and the DVP curves of 74.5 ％patients appeared to be positive phasic wave.These curve features were significantly different between the malignant lesions and benign ones (TIC:Z=-3.130,P=0.002;DVP:Z =-4.730,P =0.000).Conclusions Contrastultrasound examination shows that different tissue-derived orbital neoplasms have varied enhanced modes and types.Contrast-ultrasound examination is helpful for the differential diagnosis of orbital neoplasms.

Objective To compare the effect of hip artificial replacement and DHS internal fixation for the treatment of intertrochanteric fracture, and investigate the difference of the two method. Methods Eighty-six pa- tients with intertrochanterie fracture patients were treated with hip arthroplasty, and dynamic hip screw. The pa- tients were followed up for 6 months, and compared the operation rime, blood loss, postoperative complications, sur- vival rate, postoperative hip function score and lose situation. Results There was no significant difference in opera- tion time,blood loss,postoperative complications,in local symptoms hip varus deformation occured in the DHS inter- hal fixation because lag screw cut-our and the collapse of the medial cortex, hip and thigh pain oecured in artificial re- placement,hip function score dropped 9.5 % in DHS and 9.2% in artificial replacement. Conclusion For elderly patients, eomminuted fracture and osteoporosis, and other types of unstable intertrochanteric fracture patients, the primary purpose of surgery is to provide to patients more activities of the early conditions,so hip arthroplasty can be used to the treatment of intertrochanteric fracture,as a reasonable replacement surgery.

Objective To evaluate the ability of contrast-enhanced ultrasonography (CEUS)in differentiate reactive lymph node,metastatic lymph node and lymphoma.Methods In a prospective study CEUS was performed in 129 patients with cervical lymph node enlargement.The entire process were recorded and preserved in DICOM format.The results were registered with Sonoliver.The receiver operating characteristic curve (ROC curve)analysis was performed to find the corresponding cutoff values. The selected node was removed surgically and submitted for histology.Results Of all the nodes,26 were reactive nodes,85 were metastases and 1 8 were lymphoma.Enhancement pattern was the most accurate way to characterize lymph nodes.The enhancement pattern of reactive lymph nodes was homogeneous and most of them were enhanced by lymphatic type while the metastatic lymph nodes were inhomogeneously enhanced or weakly enhanced by peripheral type.Lymph node lymphoma usually had no fixed enhancement pattern. Arrive time (AT),rise time (RT),time to peak (TTP),mean transit time (mTT),maximum intensity (IMAX),under the curve (AUC),rising slope(Kup),semi descending slope(Kdown)and perfusion index (PI)were significantly different in the three groups(P <0.05).RT,TTP and mTT of reactive lymph nodes were the shortest,which had significant difference compared with those of metastatic lymph nodes and lymphoma (P < 0.05 ).Kup,Kdown,IMAX%,AUC,PI in the reactive lymph nodes were significantly decreased compared with the metastatic group (P <0.05),but there was no significant difference compared with those in lymphoma (P >0.05 ).When TTP≥ 7.74 s,mTT≥26.54 s,metastatic lymph nodes were considered.When RT≥4.62 s,TTP ≥ 7.74 s,mTT ≥ 28.32 s,reactive lymph nodes were not considered. Conclusions Dynamic contrast-enhanced ultrasound image and enhancement pattern can distinguish neck lymph nodes while the optimal cut-off point time of the time-intensity curve parameters can further contribute to the identification of lymph nodes.

Objective To explore the value of ultrasound-enhanced ultrasound (CEUS) in the differential diagnosis of orbital neoplasms by observing the perfusion characteristics of orbital benign and malignant neoplasms for the application of ultrasound contrast microbubbles.Methods Preoperative ultrasound imaging of 47 patients with orbital neoplasms(benign group 35 cases,malignant group 12 cases)were observed for the tumor characteristics of CEUS.The parameters of tumor imaging obtained time intensity curve (TIC) were obtained by quantitative analysis of SonoLiver analysis software,which were contrast agent arrive time (AT),rise time (RT),time to peak (TTP),mean transit time (mTT),area under the curve (AUC),maximum intensity(IMAX) and perfusion index (PI).Results Different characteristics of perfusion were shown between benign and malignant groups.Time parameters of TIC:rising slope,semidescending slope,IMAX,PI,mTT,semi-washed out time and RT were significantly different between the two groups (P ＜ 0.05) while there was no significant difference of parameters as AT,TTP,AUC.Conclusions There is certain clinical value of the CEUS in the differential diagnosis of ocular benign and malignant neoplasms.

Objective To observe the early effect of organ donation after pancreas-kidney transplantation.Methods Eight cases of diabetic nephropathy received combined pancreas kidney transplantation.There were 8 donors,including 6 males and 2 females,with an average age of (26 10) years old (range from 15 to 42 years).There were 4 cases of donors with China during the transition period of brain heart double death organ donation (C-Ⅲ) standard,3 cases of donors in line with the international standard of brain death organ donation (C-Ⅰ) standard,1 case of international standard of heart death organ donation (C-lⅡ M-Ⅲ) citizen donors.There were 6 men and 2 women for recipients of the same blood type.Results Eight cases were awake 4-6 h postoperation and the ventilator was removed 8-14 h after operation.The rehabilitation therapy began 2 days postoperation from surgery intensive care unit (SICU) to the common wards.Serum C-peptide and insulin levels achieved normal range in 1-2 weeks after transplant.Blood glucose returned to the normal level in 2-3 weeks,and the creatinine level decreased to the normal level in 2 weeks postoperation.Duodenal intramural hematoma occurred in one patient intraoperatively,and the pancreatic graft was removed for safe consideration.Other patients had no serious surgical complications within 2 weeks after transplantation.Conclusion For organ donation after death of pancreas kidney transplantation,early organ function recovered well.Under the strict preoperative evaluation,the young donors can be safely used in combined pancreas and kidney transplantation.

Objective To analyze the effect of clavicular hook plate(CHP) in treating distal clavicular fracture and acromioclavicular joint dislocation. Methods Eighteen patients with distal clavicular fracture(NeerⅡ) and acromioclavicular joint disclocation(Tossy Ⅲ) were treated by CHP. Results Sixteen patients were observed after operation,according to Lazzcano curative effect standard, fifteen cases were excellent, take 93.75 percent,1 case was good, with 6.25 percent, the excellent and good rates were 100.00 percent. The phenomenon such as the steel plate fracture,loose,escape hook and acromioclavicular joint re-dislocation were not happened. Conclusion CHP is an effective,scientific and convenience way for distal clavicular fracture and acromioclavicular joint dislocation,it worth being promoted.

Objective To investigate the characteristics of myocardial injury and its underlying mechanism in rats resuscitated from cardiac arrest. Methods Forty-two male Wistar rats were randomly(random number) assigned into the post-resuscitation (PR) 4 h, PR 24 h, PR 48 h, and sham groups. Ventricular fibrillation was induced by transcutaneous electrical epicardium stimulation and untreated for 6 min, followed by cardiopulmonary resuscitation (CPR). Myocardial function, glucose metabolism, myocardial ultrastructure, the status of mitochondrial permeability transition pore (MPTP) and mitochondrial membrane potential (MMP) were evaluated at different time points. Results Myocardial dysfunction was found at 4 h after restoration of spontaneous circulation (ROSC). The ejection fraction and cardiac output were decreased (all P<0.01), the diastole left ventricular posterior wall became thicker (P<0.01), and the end-diastolic volume was reduced (P<0.05). However, cardiac function was recovered almost completely at 48 h after ROSC. The PR 4 h group had a higher SUVmax, a more obvious decreased absorbance, and a lower MMP than the sham group (all P<0.01), but no statistically significant differences were noted between the PR 48 h group and the sham group (P>0.05). At 4 h and 24 h after ROSC, the mitochondria was swollen and the mitochondrial crista was sparse, but the myocardial ultrastructure was complete. Conclusions Post resuscitation myocardial dysfunction occurs after ROSC and the myocardial dysfunction is completely reversible at 48 h after ROSC, which may be related to the reversibility of myocardial injury and the gradual recovery of mitochondrial structure and function.

Objective To provide a reference for differential diagnosis of thyroid microcarcinoma classified as TI-RADS 3-4 grade using contrast-enhanced ultrasound.Methods SonoLiver software was used to analyze the process of contrast-enhanced ultrasound of 112 thyroid small nodules classified as TI-RADS 3-4 grade.The dynamic vascular pattern curve(DVPC)and the time-intensity curve(TIC)were automatically acquired for summarization of the types and characteristics of the two curves.The relevant parameters such as the rise time(RT),time to peak(TTP),maximum intensity(IMAX%),mean transit time(mTT),area under curve(AUC)and perfusion index(PI)were acquired and calculated using the software.Receiver operating curve (ROC) analysis was used to achieve the cut-off value of these parameters for differential diagnosis.Results For thyroid microcarcinoma which TI-RADS assessment of grade 3-4,TIC showed as slow rise and slow drop wave or slow rise and fast drop wave,DVPC showed negative waveform or negative-positive bi-directional waveform.ROC analysis demonstrated that IMAX of 96.5%,AUC of 443.08 and PI of 47.64 were the best cut-off values for the differential diagnosis of benign and malignant nodules.When IMAX<96.5%,AUC<443.08,PI<47.64,the nodules were highly likely to be thyroid microcarcinoma.Conclusions The contrast-enhanced ultrasound parameters can provide effective reference for the differential diagnosis of thyroid carcinoma with grade 3-4 in TI-RADS classification.