Objective To compare the diagnostic performances of strain elastography (SE) and shear-wave elastography (SWE) in differentiating benign and malignant solid breast lesions. Methods From January 2015 to December 2015, 150 patients with 155 lesions were examined with SE and SWE respectively in the First Affiliated Hospital with Nanjing Medical University. Elasticity scores on a improved 5-point scale,strain ratio (SR), maximum elasticity (Emax), mean elasticity (Emean), standard deviation of the elasticity (Esd) and the lesion-to-fat elasticity ratio (Eratio) were assessed. The receiver operating characteristic (ROC) curve of SE and SWE parameters were plotted to assess the value in distinguishing benign and malignant breast lesions. The results were compared using the area under the ROC curve (AUC). The accuracy of the parameters with the largest AUC were compared between SE and SWE by McNemar test in different breast imaging reporting and data system (BI-RADS) categories. Results The AUC of elasticity scores, SR, Emax,Emean, Esd and Eratio were 0.823, 0.810, 0.877, 0.835, 0.881 and 0.853, respectively. The SE and SWE parameter with the largest AUC were elasticity scores and Esd respectively. The accuracy of Esd was higher than that of elasticity scores(86.3% vs 64.7%)in 4A lesions (2=4.639, P < 0.05). There were no significant differences in accuracy in other BI-RADS categories. Conclusions Both SE and SWE were helpful for the differentiation of benign and malignant solid breast lesions, and the diagnostic performance of SE and SWE was similar. The optimization of elastography can be achieved by combination with BI-RADS.

Objective: To observe the controlled hypotension effects of nicardipine in 2 different ways for spinal tumor operalion. Methods: Twenty-four adult patients, scheduled for selective spinal tumor operation, were randomly divided into 2 groups. In groupⅠ(n=12), the nicardipine was infused at a rate of 10 μg*kg-1*min-1 and the infusion continued until MAP was at the level of 7.33-8.66 kPa, and then the rate was decreased to 1 μg*kg-1*min-1. In Group Ⅱ(n=12), nicardipine was given 0.01-0.02 mg/kg as the load dose, then infused at 1-2 μg*kg-1*min-1. Results: During the period of controlled hypotension, cardiac index(CI) increased significantly, other hemodynamic variables were stable and no hypertension rebound occurred in both groups. Reaching time of target blood pressure in groupⅡ was shorter than that in groupⅠ（P＜0.05）. The dose required to obtain target blood pressure in group Ⅱwas less than that in group Ⅰ（P＜0.05）. BP recovery time from discontinuing nicardipine infusion to pre-hypotension level,bleeding volume and transfusion volume were similar between 2 groups（P＞0.05）.During mass bleeding,　serious arrhythmia and oliguria did not occur in any case. Conclusion: Controlled hypotension with nicardipine is rapid, stable and easily controlled without hypertension rebound. Nicardipine has considerable protective effects on heart and kidney during mass bleeding. The method of bolus injection followed with intravenous infusion is more suitable to clinical application.

Objectives To explore the relevant factors of liver X receptor (LXR) and lipid metabolism in school-age chil-dren with obesity. Methods A total of 80 obese children were selected by indexes of physical growth from pupils in Grades 1-6, aged 7-14 years from June 2011 to October 2011. Fifty-one age and sex matched children with normal BMI were chosen as nor-mal controls. The metabolic indexes including aspartate transaminase (AST), alanine aminotransferase (ALT), glutamyl transpep-tidase (GGT), total cholesterol (CHOL), triacylglycerol (TG), high density lipoprotein cholesterol (HDL-C), low density lipopro-tein cholesterol (LDL-C) and expression of LXR were detected in fasting blood. Results The expression level of LXR in obese children (9.14 ± 1.15) was higher than that in control children (2.84 ± 3.68) with significant difference (t=4.55,P=0.000). Eighty percent (80%) of obese children were LXR>1 (64/80) which was higher than that of control children (23/51, 45.1%), and signifi-cant difference was found between the two groups (χ2=17.01, P=0.000). Compared to controls, the levels of AST, ALT, GGT, CHOL, TG and LDL-C were higher while the level of HDL-C was lower in obese children (P<0.05). The correlation analysis found that AST, ALT, CHOL, LDL-C and BMI were positively correlated with LXR (r=0.18~0.26,P<0.05). Logistic regression ana-lysis showed that AST≥40IU/L (OR=1.076), ALT≥40IU/L (OR=1.036), CHOL≥5.20 mmol/L (OR=2.038), LDL-C≥3.36 mmol/L (OR=2.176) and BMI≥18.9 kg/m2 (OR=1.131) were risk factors for LXR>1 (P<0.05). Conclusions Obesity in school-age chil-dren can up-regulate the expression of liver X receptor and cause liver damage and abnormal lipids metabolism.

Objective To evaluate the efifcacy and safety of Xiyanping in the treatment of hand-foot and mouth disease. Methods Based on the principles and methods of Cochrane systematic reviews, Cochrane Library, PubMed, Medline, Chinese Bio-medicine Database (CBM), China Journal Full-text Database (CNKI), VIP database and Wanfang database were searched. All of the randomized controlled trials (RCT) of Xiyanping versus ribavirin were included. The data were extracted and evalu-ated by two reviewers independently. Risk assessment tool was used to assess the risk of bias and software Revman5.0 was used for meta-analysis. Results Twenty-four RCT and 3314 patients were included. Comparing to ribavirin, Xiyanping showed better therapeutic outcomes regarding to total effective rate, durations of fever and rash elimination (RR=1.17, 95%CI:1.12~1.23;MD=-1.56, 95%CI:-2.10~-1.02;MD=-1.41, 95%CI:-1.90~-0.93). Side effects were rare in both groups and could be recovered after drug withdrawal. Conclusions The current evidence suggests that Xiyanping is superior to ribavirin in the treatment of hand-foot and mouth disease.

The effect of gelatin on anaero-cultivation of Bifidobacterium adolescent is and stabilization of its living cell in dried preparation was investigared. It was shown that the well-distributed mixture of gelatin and medium could have a cushioning effect on pH reduction resulting from acid-production while incubating, and the dried mixture comprising living cell of bifidobacterium adolescentis was prepared, in which the stability and viability of cell come from cultures of gelatin mixture was increased compared with that without gelatin mixture. It was shown that oxygen toxicity to anaerobic cell was well reduced because of cell immobilization by the gel mixure after drying with saccharide substance , and then fermentable dynamics in 50L fermentor was tested as well as the relationship of growth kinetics, pH, dissolved oxygen rate, and content of soluble solids.

Objective To investigate the cytotoxicity of vascular endothelial growth factor (VEGF) siRNA combined with fusion suicide gene yCDglyTK on human gastric cancer cell line in vitro.MethodsThe gastric cancer cell line SGC7901 was transfeeted with blank plasmid pcDNA3.1 (-) null [pcDNA3.1 (-) group], or VEGF-siRNA expression plasmid pGenesil-shVEGF (SGC7901/shVEGF group),or fusion suicide gene plasmid pcDNA3.1 (-)CV-yCDglyTK (SGC7901/CDTK group),or combined gene plasmid pcDNA3.1 (-)shVEGF-yCDglyTK (SGC7901//shVEGF-CDTK group) with calcium phosphate nanoparticles (CPNPs).Un-transfected gastric cells were set as control group.The stable transfected cells were selected by G418.The target gene expression was verified by RT-PCR and Western-blot.After given prodrug 5-fluorocytosine (5-FC), the biologic characters variation, apoptotic morphology and apoptotic rate of cells in each group were observed through cell growth curve by MTT assays, by-stander effect, Hoechst 33258 staining and flow cytometry.The data was analyzed with SPSS 13.0 software and multiple groups’ comparison was analyzed with LSD test.ResultsFour gastric cancer cells lines transfected with different plasmids were successfully established.The expression of gene yCDglyTK was detected both in SGC7901/CDTK cells and SGC7901/shVEGF-CDTK cells.By MTT assays, the cell growth curve indicated that the A570 value of SGC7901/shVEGF cells, SGC7901/CDTK cells and SGC7901/shVEGF-CDTK cells decreased significantly compared with that of SGC7901 and SGC7901/null cells after a 24-hour 5-FC treatment (P＜0.01).When the percentage of stable gene trasfected SGC7901 cells was 60％, 80％and 100％, the cell relative viability was 13.09％±2.40％, 9.74％±2.83％ and 5.68％±1.03％,respectively. A large number of cells in SGC7901/CDTK and SGC7901/shVEGF-CDTK group appeared typical apoptotic morphology under fluorescence microscope.The result of flow cytometry showed that the apoptosis rates in SGC7901/shVEG group、 SGC7901/CDTK group and SGC7901/shVEGF-CDTK group were 16.40％ ±4.68％, 57.63％ ± 4.96％ and 69.07％ ± 4.69％,respectively, and there were significant differences compared with control (P＜0.01).Conclusion VEGF siRNA combined with suicide gene can effectively kill gastric cancer cell line SGC7901.Apoptosis induction may be one of the important mechanisms of killing tumor cells.

Objective To investigate the influence of preoperative diabetes mellitus (DM) on postoperative morbidity of pancreatoduodenectomy for pancreatic ductal adenocarcinoma.Methods The clinical data of 302 pancreatic ductal adenocarcinoma patients who underwent pancreatoduodenectomy from January 1,2005 to August 31,2012 were retrospectively analyzed.Results 113 patients (37.4％)had preoperative DM among the total 302 patients.The percentage of the major complication including pancreatic fistulas,delayed gastric emptying,infections,acute kidney injury and mortality accounted for 19.9％,12.9％,25.9％,36.0％,3.2％ and 3.5％ respectively.In the DM group,firm pancreatic texture was more common than that in non-DM group (x2 =15.175,P ＜ 0.01).While pancreatic fistula in the DM group developed less frequently(x2 =7.811,P =0.005) than that in non-DM group.Delayed gastric emptying,infections,acute kidney injury,hemorrhage,pulmonary,cardiovascular and neurologic complications,as well as length of stay in hospital and mortality were in similar frequency in the two groups (P ＞ 0.05).Binary Logistic regression analysis showed DM(OR =0.358,P =0.035) and firm pancreatic texture(OR =0.395,P =0.032) were protective factors against pancreatic fistula while preoperative jaundice(OR =3.819,P =0.010) and intraoperative blood transfusion (OR =1.268,P =0.001) were predisposing factors for pancreatic fistula.Conclusions With good control of perioperative glucose level,DM does not increase operation risk in pancreatoduodenectomy for pancreatic ductal adenocarcinoma.

Objectives To investigate the serum uric acid level and its related factors in obese children. Methods Obese children were selected from all pupils (ages 7-14) of 3 primary schools. Age-and sex-matched children with normal body mass index (BMI) were chosen as normal controls. Fasting venous blood samples were collected to detect uric acid (UA), glucose (GLU), total cholesterol (CHOL), triacylglycerol (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipopro-tein cholesterol (LDL-C). Results Sixty-eight (2.2%) obese children (57 boys and 11 girls) were detected from 3 000 children. Compared with 136 normal controls, the blood pressure (BP), levels of UA, CHOL, TG and LDL-C, and waist circumference (WC) were higher while HDL-C was lower in obese children (P<0.05). The detection rate of hyperuricemia in obese children (35.3%) were signiifcantly higher than that in normal controls (5.9%) (P<0.05). UA was positively related with WC, BMI, BP and TG, negatively related with HDL-C. Conclusions Obesity can lead to higher serum UA, higher BP and abnormal lipid metabolism. The level of serum UA was correlated with BP and abnormal lipid metabolism.

Objective To investigate the efficacy and safety of hypertonie saline enhanced radiofrequency ablation (RFA) in the treatment of liver cancer. Methods The clinical data of 42 patients with primary liver cancer (n = 28) or metastatic liver eancer (n = 14) who had been admitted to First Affiliated Hospital of Nanjing Medical University from September 2001 to December 2007 were collected. Forty-eight lesions were detected with a diameter ranging from 1.2 cm to 7.5 cm. RFA electrode and 20G needle were pricked into the target lesion under the guidance of B ultrasound or computed tomography (CT) through percutaneoas puncture or open approaches. An amount of 5-10 ml hypertonie saline was infused through the needle at regular intervals during RFA. All patients were followed up for 3-79 months. Contrast-enhanced ultrasound and CT scanning were performed postoperatively to determine the efficacy of RFA. The levels of alpha-fetoprotein (AFP) before and after treatment were compared using t test, and the survival of the patients were analyzed using a Kaplan-Meier survival curve. Results The AFP expression changed to negative in 14 out of the 18 AFP-positive patients, with statistical difference (t =7.703, P <0.05). The complete necrosis rate of tumors was 94% (45/48), and the necrosis rate of tumors with diameter of ≤4.0 cm reached 100% (35/35). The incidence of complication was 5% (2/42). No perioperative mortality occurred. The 1-, 2-, 3-year survival rates were 91%, 85% and 70%, respectively. Conclusions Hypertonic saline enhanced RFA in the treatment of liver cancer was proved to be safe and effective.

Objective: To investigate jugular bulb venous oxyg en partial pressure(PjO2)， hemoglobin saturation (SjO2) and the arterial t o jugular bulb venous oxygen content difference(AjDO2) during anesthesia with desflurane and isoflurane in patients with brain tumor. Methods: Fifty-six patients with brain tumor were randomized into desflur ane or isoflurane for maintaining anesthesia. PjO2, SjO2 and AjDO2 in pati ents were measured during normoventilation, hyperventilation and hypoventilation . Results: During normoventilation， SjO2 and PjO2 in desflu rane group was significantly higer than those in isoflurane group（P<0.05 or P<0.01）, and AjDO2 in desflurane group was significantly lower than that in isoflurane group（P<0.05）.Except that PjO2 in desflurane group was si gnificantly higer than that in isoflurane group during hyperventilation （P< 0.01）, there were no differences in SjO2, PjO2 or AjDO2 between the 2 g roups during hyperventilation or hypoventilation. While anesthesia with desflura ne and isoflurane, there was a positive correlation between PaCO2 and SjO2. Conclusion: At the same anesthetic effect concentration, desflur ane can significantly increase SjO2 and PjO2 in comparison to isoflurane un der normoventilation, suggesting that desflurane may have stronger effect of rel axing cerebral vessel than isoflurane.