Objective To investigate the value of contrast enhanced ultrasonography ( CEUS) in the diagnosis of hepatic epithelioid hemangioendothelioma( HEHE) . Methods The images of CEUS had been retrospectively evaluated in 21 lesions of HEHE which were confirmed by pathology . The perfusion patterns and time of enhancement were observed ,including time to begin enhancement , time to peak enhancement ,the washout time and the appearance of internal structures . Results The mean time of begin enhancement ,time to peak ,time to isoechogenity and hypoechogenity were ( 17 .4 ± 5 .2) s ,( 22 .0 ± 7 .2) s , ( 23 .9 ± 4 .6 ) s and ( 42 .2 ± 13 .7 ) s ,respectively . During the arterial phase , 8 lesions showed diffuse enhancement ,7 lesions showed rim-like enhancement and 6 lesions showed branch enhancement . The inner margin in 6 lesions showed speculate enhancement . The central portion of the tumors was not enhanced in part lesions of 8 cases . As to time of peak enhancement ,compared to the normal hepatic parenchyma , hypoenhancement ,isoenhancement and hyperenhancement were observed in 10 lesions ,6 lesions and 5 lesions respectively . Synchronous enhancement was observed in 11 lesions on CEUS ,rapid enhancement was observed in 8 lesions and slow enhancement was observed in 2 lesions . Twenty-one lesions manifested hypoechoic mass in portal phase and delayed phase . The boundary of lesions was unclear on conventional ultrasound and became distinct after contrast injection in 21 lesions . Conclusions CEUS is useful for the diagnosis of HEHE .

Purpose To analyze and compare the imaging characteristics of contrastenhanced ultrasound (CEUS) and dynamic contrast-enhanced CT for hepatic epithelioid hemangioendothelioma (HEHE) diagnosis.Materials and Methods The imaging characteristics of CEUS and dynamic contrast-enhanced CT performed on 16 patients with pathological-confirmed HEHE were retrospectively analyzed.Dynamic contrast-enhanced CT was performed on 5 patients,real-time CEUS was performed on 8 patients,and both examinations were performed on 3 patients.Results On CEUS,14 lesions were selected from 11 HEHE cases.In the case of enhancement mode,5 lesions displayed ringenhancement,and 9 lesions displayed global enhancement;in the case of arterial phase,11 lesions were synchronously enhanced,and 3 lesions were rapidly enhanced compared with liver parenchyma;in the case of peak time,hyper-enhancement,iso-enhancement and hypo-enhancement were observed in 2 lesions,9 lesions and 3 lesions,respectively;all 14 lesions manifested hypoechoic mass in portal phase and delayed phase.On dynamic contrast-enhanced CT,29 lesions were found in 8 HEHE cases.In the case of arterial phase,9 lesions (31.0％) showed slight inhomogeneous enhancement,4 lesions (13.8％) showed no obvious enhancement and 16 (55.2％) lesions showed slight edge enhancement;all 29 lesions presented continuous hypo-enhancement in delayed phase.Conclusion Both CEUS and dynamic contrast-enhanced CT have respective characteristic manifestations,and are of high value for the diagnosis of HEHE.

Objective To analyze and compare the imaging characteristics of contrast-enhanced ultrasound (CEUS) and contrast enhanced magnetic resonance imaging (CEMRI) in diagnosing hepatic epithelioid hemangioendothelioma (HEHE) for improving radiological diagnostic accuracy.Methods The imaging characteristics of CEUS and dynamic CEMRI in 17 patients with histopathological diagnosis of HEHE on specimens obtained after surgical resection or fine needle biopsy were retrospectively analyzed and compared.Results On CEUS,20 lesions in 13 patients demonstrated different enhancement patterns in the arterial phase:13 lesions (65.0％) displayed gross enhancement and 7 lesions (35.0％) displayed a rimlike enhancement.Synchronous enhancement was observed in 17 lesions (85.0％) and rapid enhancement was observed in 3 lesions (15.0％).All these 20 lesions manifested as a hypoechoic mass in the portal venous and delayed phases.Other characteristics included speculated enhancement in the inner margin of the lesions and a vessel sign.On CEMRI,45 lesions (71.4％) manifested slight enhancement in the arterial phase and continuous enhancement in the portal venous and delayed phases.The remaining 18 lesions (28.6％) manifested no enhancement in the arterial phase but progressive enhancement in the portal venous and delayed phases.47 lesions (74.6％) displayed a rim-like enhancement and 16 lesions (25.4％) displayed gross enhancement.Other imaging characteristics included a halo sign,a lollipop sign,a capsular retraction sign or avessel sign.Conclusions On CEUS,characteristic manifestations of HEHE were synchronous enhancement with a quick wash-out.At peak time,the enhancement degree was equal to the normal liver parenchyma.On CEMRI,the main radiological feature of HEHE was a rim-like enhancement.In the arterial phase,the enhancement degree was not high and there was either a continuous enhancement or a progressive enhancement in the portal venous and delayed phases.Furthermore,HEHE lesions always occurred under the liver capsule and showed acapsular retraction sign,ahalo sign,a lollipop sign or a vessel sign.The combination of CEUS and CEMRI helped to improve the diagnostic rate and contributed to selection of clinical treatment.

Objective To investigate the common initial clinical presentations of primary Sj(o)gren's syndrome (pSS) with pulmonary complications,and to explore the differences between patients with extraglandular manifestations at disease onset (EGM) and those with glandular manifestations at disease onset (GM).Methods A total of 1 341 hospitalized SS patients from 2003 to 2012 were retrospectively reviewed.Of them,102 hospitalized patients with pSS'associated lung disease were analyzed and included.Case control study was performed to explore the differences between the EGM group and the GM group.Results Fifty-one percent of patients were presented with EGM at onset,with significantly shorter disease duration [36 (12,156) m vs 102 (48,159) m,x2=-2.41,P=0.016].Although the mean diagnose time was similiar,only 4％ of the EGM group could be confirmed the pSS diagnose at onset,which was significantly less frequently than that of the GM group (34％,22=15.29,P＜0.01).Case control study revealed that hyperglobulinemia,elevated RF titers and anti-SSA and/or anti-SSB test positive were less predominant in the EGM group [IgG 16(12,21) g/L vs 21 (15,28) g/L,x2=-2.15,P=0.032;22 (20,171) U/ml vs 104 (20,238) U/ml,x2=-l.98,P=0.048;33％ vs 72％,x2=15.78,P＜0.01].The predicted value of TLC and FVC were lower [(87±23)％ vs (97±20)％,x2=-1.96,P=0.050;(8±28)％ vs (100±27)％,x2=-1.70,P=0.089] and HRCT score was higher in EMG group [12(88,15) vs 8(5,13),x2=-1.82,P=0.070].Conclusion EMG at onset is the common initial manifestation of pSS'associated lung involvement.Pulmonary complication is more progressively and severe than those with MG at onset.Anti'SSA positive,elevated RF titer and hyperglobulinemia are not predominant for patients with EMG at onset.

There are three types of glial cells in(for short): sheath glia, socket glia and glutamate receptor glia. They are mainly located in four sensory organs including the amphid, the cephalic organ, the outer labial sensilla and the inner labial sensilla.glial cells play key roles in dendrite extension, neurite guidance and extension, and are essential for synaptogenesis and maintain the normal morphology and the function of sensory nerve endings as well. A recent study shown that some nematode neurons are derived from the glial cells. Moreover, nematodes glial cells can directly modulate the function of sensory neurons. Some glial cells can also respond to certain external stimuli, such as mechanical stimulation, and adjust the accompanying neuronal activities.The article summarizes the progress on effects of nematodes glial cells on the nervous system development and function.

Objective To retrospectively analyze the contrast-enhanced ultrasound(CEUS)features of metastatic hepatic neuroendocrine neoplasm(MHNEN)and their diagnostic value.Methods Twenty-eight patients with 35 MHNEN lesions were enrolled in this retrospectively study and underwent CEUS examination.The dynamic enhancement features,including enhancement pattern,peak intensity,and washout pattern were analyzed.Results The arrival time of contrast agent,time to peak,time to iso-echogenity and time to hypo-echogenity was(15.96 ± 4.14)s,(21.42 ± 5.01)s,(29.41 ± 4.83)s and (42.06±22.84)s,respectively.Compared with adjacent liver parenchyma,rapid enhancement,synchronous enhancement and slow enhancement were found in 42.9% (15/35),48.6%(17/35),8.5%(3/35) of MHNEN lesions,respectively.As for enhancement patterns,82.9%(29/35)of MHNEN lesions showed global enhancement,while 17.1%(6/35)showed rim-like enhancement.In addition,22.9%(8/35)of the selesions had a centripetal pattern during the arterial phase.Compared with liver parenchyma,all lesions demonstrated hyper-enhancement at peak enhancement.In portal venous phase,68.6%(24/35)of MHNEN lesions presented marked hypo-enhancement and 31.4%(11/35)with slight hypo-enhancement.And in late phase,all the lesions showed marked hypo-enhancement.Moreover,the boundaries of the lesions became distinct after contrast injection and another 36 lesions were identified on CEUS compared with conventional ultrasound.Conclusions CEUS can afford more diagnostic information of MHNEN and may be a good technique for diagnosing MHNEN.

Objective To analyze the imaging characteristics of contrast-enhanced ultrasound(CEUS) and dynamic contrast enhanced magnetic resonance imaging ( CEMRI) for diagnosis of hepatic epithelioid hemangioendothelioma ,and to increase the accuracy of diagnostic imaging . Methods The imaging characteristics of CEUS and dynamic CEMRI in 11 patients with hepatic epithelioid hemangioendothelioma confirmed by surgical pathology or fine needle aspiration biopsy were retrospectively analyzed . Results On conventional ultrasound ,14 lesions in 11 patients showed hypoechoic . The peripheral blood flow was detected in most patients by color Doppler flow imaging and the average resistant index was 0 .62 ± 0 .05 . During the arterial phase ,6 lesions showed diffuse enhancement ,6 lesions showed annular enhancement and 2 lesions showed branch enhancement .As to time of peak enhancement ,compared to the normal hepatic parenchyma ,hypoenhancement ,isoenhancement and hyperenhancement were observed in 1 lesion ,7 lesions and 6 lesions respectively . Synchronous enhancement was observed in 8 lesions on contrast-enhanced ultrasound ,rapid enhancement was observed in 5 lesions and slow enhancement was observed in 1 lesion and all lesions decreased quickly in portal phase and delayed phase . On CEMRI ,all lesions showed low signal on TIWI ,high signal on T2WI and DWI . There were 5 lesions showed obvious annular constant enhancement and 1 lesion showed obvious annular progressive enhancement . Progressive peripheral enhancement and fully filling in delayed phase were found in 4 lesions .While progressive peripheral enhancement and incompletely filling in delayed phase were found in 3 lesions . One lesion displayed constant enhancement and incompletely filling in delayed phase . Halo sign" , lollipopsign" , capsular retraction sign" and vessel sign" were appeared in 6 ,7 ,8 and 8 patients respectively . Conclusions Both contrast-enhanced ultrasound and CEMRI have characteristic manifestations for the diagnosis of hepatic epithelioid hemangioendothelioma and cominbing them would be great significance to improve the preoperative diagnostic accuracy .

Acupuncture can improve the motor and non-motor symptoms of Parkinson's disease, and the effect of acupuncture combined with drug therapy is better than that of drug therapy alone. The possible mechanism includes inhibiting α-synuclein aggregation, oxidative stress, and neuroinflammation, inhibiting the apoptosis of dopaminergic neurons, and achieving a neuroprotective effect. The points mainly selected for Acupuncture treatment for this disease are Zusanli (ST 36), Yanglingquan (GB 34), Taichong (LR 3), Xuehai (SP 10), and other points. Early use of acupuncture and acupuncture combined with medical treatment strategy is worthy of clinical application.

Objective To explore the support status in nursing work among the second grade hospitals from such perspectives as the allocation of nursing human resources, logistics support system and nursing management model in the central and eastern regions of China. Methods Totally 63 second grade hospitals in 13 provinces were investigated by a self-designed questionnaire including the general information, general hospital circumstances, construction of nurse team, hospital logistic support, nursing function, etc. Results Among 63 second grade hospitals, all of them had adopted responsibility nursing system, and 82. 54%hospitals were going to the stage of “start, prepare, acquire achievement” for nurse position management. For nurse allocation, bed/nurse ratio was 1 ∶ (0. 54 ± 0. 17) in average, and 39. 68% of hospital own less than 50% of nursing graduated from junior college or beyond, 58. 73% of hospital having more then 60% of nurses occupying Charge Nurse occupational title or below, 73. 2% of hospital having more than 25% of nurses less than 3 years work experience, and 69. 84 of hospital having no personal care assistant. Logistics support system:only 30. 2% hospitals had care works and 12. 7% hospitals had full-time staff to configuration intravenous fluid. In the logistic support system, more than 50% hospitals already arrange specially-assigned person for collecting and sending sterilize items, specimen, sending patients for examination, maintaining ward order and clean, but just 12. 7% hospital had specially-assigned person for IV liquid configuration. At the aspect of nursing management, there were over 90% hospital carrying out quality control management, in service, nurses resource adjustment within hospital, 61. 9% hospital involving nursing recruitment and nurse manager appointed and dismissed, 41. 27% hospital distributing money award by job performance. Conclusions The hospitals in the central and eastern regions of China have widely practiced quality care service and gradually implement nurse position management. In the support system for care work, the allocation of human resources have improved. However, the team structure still shows the young age, low job title and educational level, still having gap with national one two five planning. In addition, logistics support system needs to be improved and the vertical management doesn′t carry out well. Second grade hospitals would strengthen the support for care work based on their own features so that it can promote the process of nursing reform.