Objective To investigate the value of contrast enhanced ultrasound (CEUS) in diagnosing poor differentiated cholangiocarcinoma. Methods Sonograms of 11 patients with pathologically confirmed poor differentiated cholangiocarcinoma were retrospectively analyzed. The size, boundary, shape, echo, blood distribution and characteristics of the enhancement duration were observed. Results All lesions presented irregular shape (100%), most (9/11, 81.82%) with indefinite boundary, some (6/11, 54.55%) with low echo. No blood flow signal was found in the interior of masses, while grade 1 blood flow signal was detected in periphery of the lesions. Resistance index (RI) was ≥0.6 in spectral Doppler in 7 (63.64%) lesions. Marginal rim-like hyperechoic enhancement in the arterial phase was found without centripetal filling in all 11 patients, marginal rim-like hypoechoic enhancement was observed, but being hyperecho compared with interior part without medium in delayed phase. Conclusion The contrast-enhancement modality of poor differentiated cholangiocarcinoma is characteristic. Combined with two-dimensional ultrasonography and color Doppler ultrasound, the diagnostic rate will be improved.

Based on the questionnaires completed by 985 medical students,this article finds out that female students value more on the factors of health care and development when choosing a job,while male students are more confident in selecting goals and making career plans.Students from different family backgrounds have great difference when facing the elements such as reputation,social status and selfevaluation.Students from different majors take quite different opinions to health care,self evaluation,career information and career planning.There is little difference among different grades of medical students.Vocational values correlate positively with career decision-making self-efficacy.

The application of evidence-based medicine in bibliotherapy is defined as evidence-based bibliothera-py.After a description of the connotation, role and significance of bibliotherapy, and foreign and domestic studies on it, the problems in domestic bibliotherapy were pointed out with measures put forward for their solution, and the implementation of bibliotherapy was normalized in view of its methodology.

Neuroblastoma(NB)is the most common extra -cranial malignant tumor of children.While it ac-counts for 7% of all childhood malignancies,NB accounts for 1 0% of childhood cancer mortality.According to the risk group classification systems,there is high heterogeneity malignant degree of NB.Many bio -features are associated with the prognosis of NB.As the development of the diagnosis and therapy,the relationship between some bio -features and the prognosis has been changed.In the future,target therapy of molecular biology may be a new breakthrough in the therapy area.

Objective To investigate the expression level and clinical significance of serum IL-18 and MCP-1 in patients with Chronic Obstructive Pulmonary Disease(COPD).Methods Serum IL-18 and MCP-1 levels were measured in healthy people( control group,30 cases) and in patients with COPD (acute stage group and stable stage group,30 cases in each group).At the same time,the level of serum CRP and forced expiratory volume in one second ( FEV1 ),the forced expiratory volume in one second/forced vital capacity ( FEV1/FVC％ ) were tested in the three groups.The variation.of the level of serum IL-18 and MCP-1 and the correlation between these index with lung function and CRP were analyzed.Results The levels of serum IL-18 and MCP-1 in acute stage group ( IL-18 [ 69.29 ± 16.14 ] ng/L,MCP-1 [ 123.95 ± 32.06 ] ng/L) were significantly higher than those in stable stage group ( IL-18 [ 53.15 ± 14.74 ] ng/L,MCP-1 [ 96.46 ± 18.24 ] ng/L) ( F =10.975,P ＜0.01 ),and also significantly higher than those in control group ( IL-18 [ 37.53 ± 14.55 ] ng/L,MCP-1 [60.86 ± 17.26] ng/L) ( F =18.101,P ＜ 0.01 ).In acute stage group,positive correlations were obtained among the level of serum IL-18,MCP-1 and CRP ( r =0.688,P ＜ 0.05 ; r =0.663,P ＜ 0.05 ; r =0.825,P ＜0.01 ),and they were correlated negatively with FEV1 and FEV1/FVC％ ( r =- 0.732,P ＜ 0.01 ;r =- 0.586,P ＜0.05 ).In stable stage group,the level of serum MCP-1 was correlated positively with the level of IL-18( r =0.674,P ＜ 0.05 ) and with the level of CRP ( r =0.719,P ＜ 0.05 ),but it was correlated negatively with FEV1 and FEV1/FVC％ ( r =-0.512,P ＜ 0.05 ;r =-0.557,P ＜ 0.05 ).Conclusion The serum IL-18 and MCP-1may be one of the inflammation markers in patients with COPD and may be associated with airway inflammation and limited airflow.

During the treatment of pediatric tumor,vincristine is one of the most widely used and most effective drugs. However,the adverse reactions have limited its clinical application. In recent years,studies have found that the metabolism of vincristine are different in different races and different individuals,and co-ad-ministration with certain drugs such as imidazoles antifungal drugs may enhance its adverse reaction. Resear-ches on new drug delivery system provide a new idea for reducing the adverse reactions of vincristine and impro-ving its bioavailability.

Objective To study the effects of mild hypothermia on endothelial cell of cerebral vessels in patients with moderate or severe cerebral infarction. Methods Sixty patients with moderate or severe cerebral infar-ction were divided into 2 groups: a mild hypothermia group (30 cases) and a non-mild hypothermia group (30 cases). Endothelin (ET), endothelial nitric oxide synthases(eNOS) and von Willebrand factor(vWF) were tested with RIA or ELISA. All the patients were treated with routine medication, in addition, those in mild hypothermia group were also treated with mild hypothermia. Results The ET and vWF levels of serum and cerebrospinal fluid (CSF) in patients of mild hypothermia group were significantly lower than those of non-mild pothermia group (P

Background Prostaglandin eye drops is front-line medicines of lowing intraocular pressure for primary open angle glaucoma (POAG),but its price is higher for long-term application.Domestic latanoprost drops has been applied in clinic.However,its trial of lowing intraocular pressure effect and safety from sizable sample and multi-center is lack.Objective This study was to observe the efficacy and safety of domestic latanoprost for POAG and ocular hypertension.Methods This prospective,multicenter trial was conducted at 25 hospitals in 5 territories of China,and 837 eyes of 576 patients with POAG and ocular hypertension were recruited in the hospitals based on the uniform criteria.Domestic latanoprost drops was topically used once per day at night for 3 months.Intraocular pressure (IOP) was measured 1 month and 2 months,3 months to assess the efficacy of drug,and vision acuity,blood pressure,pulse,ocular symptoms and signs were observed to evaluate the safety of the drug.This study approved by the Ethics Committee of Wuhan General Hospital of Guangzhou Military Command,and all patients were informed consent and signed informed consent.Results IOP was (28.36±7.86),(19.66±5.46),(19.59±7.86) and (19.35 ± 5.03) mmHg in pretreatment and posttreatment 1 month,2 months and 3 months,respectively,showing a significant difference among various time points (F =748.325,P =0.000),and the IOPs were markedly lower in posttreatment than those in pretreatment (all at P＜0.001).The falling range of IOP was (30.43 ±7.18)％,(30.19 ± 8.72)％,(30.71±9.90) ％ in posttreatment 1 month,2 months and 3 months,respectively.The efficiency was 95.70％,91.76％ and 88.05％ in 1 month,2 months and 3 months.Conjunctival hyperemia was observed in 13％ eyes at the end of following-up.No drug-related systemic and other ocular adverse reactions were found.Conclusions Domestic latanoprost drops can low IOP effectively without serious adverse reaction in POAG and ocular hypertensive patients.

Objective To explore the postoperative observation and nursing of double intervention therapy in patients with hepatocellular carcinoma accompanying hypersplensim.Methods The nursing of 30 patients with hepatocellular carcinoma accompanying hypersplensim who received hepatic arterial embolization combined with partial splenic embolization was retrospectively analyzed.Adverse events and nursing experience were summarized.Results All patients had varying degree of fever,abdominal pain,nausea,vomiting and other side effects.The tumor size was reduced and white blood cells and platelets increased to varying degrees.Hypersplenism was relieved after treatment,and serious complications didn't occur.All 30 cases were discharged.Conclusions In double interventional therapy for hepatocellular carcinoma accompanying hypersplenism,nurses must closely observe the disease and take measures to treat the postoperative side effects and serious complications,and promote the rehabilitation of patients.

Objective To investigate into the indications and related anatomic foundation of transjugular intrahepatic portosystemic shunt(TIPS) creation by direct transcaval approach in patients with portal hypertension cirrhosis suffering unusual anatomy between the hepatic veins and portal bifurcation; and to evaluate the security, feasibility and clinical significance. Methods Direct transcaval approach TIPS were performed in 65 patients including active variceal bleeding (n=52), intractable ascites (n=12), and as a bridge to liver transplantation (n=1). Results Technical and functional success were achieved in all patients. The success rate was 100% without related complications including the technique and primary patency rate is obvious higher than classical TIPS. Conclusion In patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins, transcaval TIPS creation is secure and feasible. The results suggest that the direct transcaval approach offering favorable primary patency because the shunt has a straight line in construction.