Objective To evaluate the efficacy of lamivudine and adefovir in the treatment of patients with decompensated hepatitis B cirrhosis . Methods 90 cases of patients with hepatitis B cirrhosis of the liver decompensation period from August 2013 to June 2015 in our hospital were researched.According to the random number table method divided into observation group and control group , each of 45 cases, the total course of treatment was one year.The observation group was treated with lamivudine combined with adefovir dipivoxil , control group was treated with lamivudine.The clinical effect, the indexes of liver function, the changes of HBV-DNA and Child-pugh score were compared between the two groups after treatment.Results After treatment, the total effective rate of the observation group ( 93.33%) was obviously higher than that of control group (48.89%), the difference was statistically significant (P<0.05), the observation group alanine amino acid, total bilirubin, aspartate aminotransferase were (71.23 ±21.32)U/L, (28.32 ±4.65)Umol/lL, (4.65 ±9.25)U/L, they were significantly lower than control group (111.54 ±16.25)U/L, (46.53 ±4.89 ) Umol/L, ( 4.89 ±12.11 ) U/L, the observation group albumin ( 39.82 ±2.62 ) g/L was significantly higher than control group (35.55 ±2.22)g/L, the difference was statistically significant (P<0.05), after treatment, the observation group hepatitis b HBV DNA levels, Dhild pugh score (2.78 ±0.45)log10 copies/mL, (6.12 ±1.23) were significantly lower than the control group (3.89 ±0.65)log10 copies/mL, (7.89 ± 1.21)scores, the difference was statistically significant (P <0.05).Conclusion The combination of lamivudine and adefovir dipivoxil significantly decompensated hepatitis B cirrhosis has a curative effect, it could effectively improve the patient's liver function, Dhild-pugh score, HBV-DNA level.

Objective To investigate the diagnostic value of dual energy CT for small central cervical metastatic lymph nodes in patients with papillary thyroid cancer.Methods The data of 43 patients with thyroid papillary carcinoma confirmed by pathology were retrospectively analyzed.All of the patients underwent dual energy CT scan before operation.The short diameter,iodine concentration and normalized iodine concentration (NIC) of enhanced arterial and venous phases and the slope of the energy spectrum curve were analyzed between metastatic central cervical lymph nodes and non-metastatic lymph nodes.ROC curve was used to analyze the diagnosis efficacy of iodine concentration and NIC for metastatic lymph nodes of thyroid carcinoma.Results Totally there were 119 lymph nodes in 43 patients included 55 thyroid papillary carcinoma metastasis lymph nodes (metastasis group) and 64 non-metastatic lymph nodes (non-metastasis group).There was significant differences of the mean short diameter of the lymph nodes between the two groupos (t=-2.20,P=0.03).In arterial phase,the average iodine concentration of metastasis group and non-metastasis group were (2.93±1.62)mg/ml and (2.17±1.09)mg/ml;the NIC were 0.33±0.21 and 0.19 ± 0.12;and the slope of the energy spectrum curve were 0.79±0.43 and 0.63±0.37 respectively.In venous phase,the average iodine concentration of metastasis group and non-metastasis group were (2.68± 1.54) mg/ml and (2.17 ± 1.01) mg/ml;the NIC were 0.51 ± 0.18 and 0.43 ± 0.15;the slope of the energy spectrum curve were 0.54 ± 0.42 and 0.62 ± 0.39 respectively.The iodine concentration and NIC in both phases and the slope of spectrum curve in arterial phase had statistical differences between the metastasis and non-metastasis groups (all P＜0.05).ROC curve showed that the area under the curve (AUC) of iodine concentration and NIC in the diagnosis of metastatic lymph nodes were 0.62 and 0.73 in arterial phase,respectively.And the AUC of iodine concentration and NIC were 0.61 and 0.63 in venous phase,respectively.Conclusion There are differences of iodine concentration,NIC in arterial and venous phases and curve slope in arterial phase of dual-energy between malignant and benign central cervical lymph nodes in thyroid papillary carcinoma.Dual energy CT technology is helpful in identifying of metastatic from non-metastatic small central cervical lymph nodes.

Purpose To investigate the value of dual-source CT with dual-energy virtual non-contrast imaging in the diagnosis of cervical lymph node disease. Materials and Methods The dual-energy scan data of 126 lymph nodes from 50 patients confirmed pathologically were reviewed. The difference of average CT value, signal to noise ratio, contrast to noise ratio, image subjective assessment and lesion detectability between virtual non-contrast imaging and conventional non-contrast scan were analyzed. The radiation dose of virtual non-contrast imaging and real non-contrast imaging of cervical lymph node were also compared. Results ①The consistency of virtual plain scan combined with dual-energy contrast imaging in the diagnosis of six typical pathological types were all satisfactory (Kappa>0.7, P<0.01), and the detection rate of non-specific lymphadenitis, lymphomas and lymph node metastasis of thyroid carcinoma was higher among the six types (93.1%, 86.7% and 100.0%, respectively, Kappa=0.983, 0.893; P<0.01), and had the highest detection rate of lymph node metastasis of thyroid carcinoma (100.0%, Kappa=1.000, P<0.01). ②There was no significant difference among the average CT, signal to noise ratio and contrast to noise ratio of conventional scan and virtual non-contrast imaging during arterial phase and venous phase (H=3.125, 4.374, 4.037;P>0.05).③ Compared with conventional enhanced scan, dual-energy phases reduced radiation dose by about 19%. Conclusion Dual-energy virtual non-contrast imaging combined with contrast imaging can provide clear images in the diagnosis of enlarged cervical lymph nodes and reduce radiation dose of subjects, thus can be expected to replace real scan.

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PurposeTo explore the significance of dual energy CT in differential diagnosis of squamous cell carcinoma metastatic lymph nodes and lymph node tuberculosis in the neck.Material and Methods Twenty-five patients with a total of 62 cervical enlarged lymph nodes confirmed with squamous cell carcinoma metastasis or lymph node tuberculosis by pathology underwent dual energy enhanced CT scan. Iodine coverage value of two different kinds of pathological properties of lymph nodes was measured. The trend of the spectrum curve was observed and the energy spectrum curve slope of two kinds of lymph nodes were compared. The sensitivity, specificity and accuracy of energy spectrum curve slope in differential diagnosis were analyzed. Results Of all 62 lymph nodes, there were 32 squamous cell carcinoma metastatic lymph nodes and 30 lymph node tuberculosis. There were statistic significance in the iodine coverage between the squamous cell carcinoma metastatic lymph nodes and lymph node tuberculosis (t=3.806 and 3.698,P<0.05). In the range from 60 keV to 180 keV, CT value of the two kinds of lymph nodes decreased with increase of keV value. It showed the higher the keV value the less CT value decreased, with the energy spectrum curve of drop type. The area of the iodine coverage was 0.756 with the differential diagnostic sensitivity of 56% and the specificity of 80%. The area of energy spectrum curve slope was 0.898 with the differential diagnostic sensitivity of 76% and the specificity of 85%.Conclusion The iodine coverage value and the energy spectrum curve slope have significance in differential diagnosis of the cervical squamous cell carcinoma metastatic lymph nodes and lymph node tuberculosis. The energy spectrum curve slope is superior to the iodine coverage value in differential diagnosis.

Objective To investigate the diagnostic value of cervical metastatic lymph nodes by T1 perfusion-weighted imaging and analyse the effect of age on perfusion.Methods 18 cases of cervical lymph node metastasis (case group)and 30 healthy people (control group)were performed T1 perfusion-weighted imaging.The semi-quantitative parameters (including in maximum relative enhancement ratio,wash in rate,wash out rate and peak time)and time-intensity curve (TIC)were compared between case group and control group.Moreover,the effect of age on perfusion was investigated by the age of 40 years old.Results The inflow rate was statistically significant difference between the two groups (P<0.05)and that of 23 cases of metastatic lymph nodes was higher than 49 normal lymph nodes.However,the maximum relative enhancement ratio,outflow rate and peak time weren’t statistically signif-icant difference(P>0.05).The time-intensity curve in metastatic lymph nodes and normal lymph nodes were common in typeⅡ. The maximum relative enhancement ratio and wash in rate negatively correlated with the age and the maximum relative enhancement ratio and wash in rate below the age of 40 years old were higher than above the age 40.Conclusion The wash in rate is helpful to dif-ferentiate metastatic lymph nodes and normal lymph nodes.The effect of age on perfusion is considered.

Objective To explore the value of spectral imaging technique in dual-energy CT in differential diagnosis of the metastatic lymph nodes in thyroid carcinoma,squamous cell carcinoma metastatic lymph nodes and lymphoma in the neck.Methods In 30 patients with pathologically confirmed with a total of 79 cervical lymph nodes enlargement which were using dual energy scan .Then observed the change trend of the spectrum curve and comparison the three kinds of lymph node energy spectrum curve’s slope.Results In the 79 lymph nodes,the metastatic lymph nodes in thyroid carcinoma were twenty-three,squamous cell carcinoma metastatic lymph nodes were twenty-four and lymphoma were thirty-two.From 60 to 180 keV,with the increase of keV values,the three kinds of malignant lymph nodes of the corresponding CT value decreasing and the higher the keV value,the CT value decrease magnitude was small,and the spectrum curve was〞drop type〞.The slope spectrum curve of the metastatic lymph nodes of thyroid carcinoma in arterial phase and parenchymal phase were maximum,which were 1.23±0.41 and 0.85±0.33,respectively.The slope spectrum curve of lymphoma in arterial phase and parenchymal phase were least,whcih were 0.40±0.16 and 0.47 ±0.09.The slope spectrum curve of the squamous cell carcinoma metastatic lymph nodes in arterial phase and parenchymal phase were 0.88±0.10 and 0.62±0.28.The energy spectrum curve slope of the three kinds of malignant lymph nodes have statistical significance.Conclusion The energy spectrum curve slope of arterial phase and parenchymal phase has some significance lymph node metastasis of in thyroid carcinoma,the metastatic lymph nodes and lymphoma in the neck.

Objective To evaluate a model of management for chronic pain disease coordinated community health services and district hospital. Methods The epidemiology of chronic pain disease was surveyed in Haotao community of Zhongshan, before and after the establishment of the model of management. Results The prevalence rate of chronic pain disease was 51.83%, in which it was 47.06% in men, and 57.32% in women. After the establishment of the model, the efficacy of good to excellent improved from 30.22% to 67.08%, the cost for medicine reduced 36.16%, time for rest reduced from 32.42 d to 15.25 d (P<0.05). Conclusion The model of management that coordinated community health services and district hospital, including demonstration diagnosis and treatment through internet, tele-consultations and health education, is effective on chronic pain disease.

Objective:To explore the clinical characteristics and genetic characteristics of gene mutation of pyruvate dehydrogenase E1α deficiency.Methods:The clinical and genetic characteristics of a rare girl infant with pyruvate dehydrogenase E1 α deficiency confirmed by Hebei General Hospital were retrospectively analyzed, and the literature was reviewed combined with the research progress of the disease.Results:The rare case of baby girl, early onset, psychomotor development is severely backward, persistent hyperlactic acid and hyperpyruvemia, metabolic acidosis, the head MRI shows septum pellucidum is small, interventricular septum is absent; fornix is unclear, splenium of corpus callosum is small and extruded forward like a canopy.The top of the third ventricle is elevated to the dorsal side, the left paracele enlarge to the right, the left interventricular foramen is obviously enlarged.Intermittent periods EEG: a large number of medium and high amplitude spike slow waves, slow waves, and a small amount of multiple spike slow waves are scattered or continuously distributed in the left posterior head (O1, T5). A large amount of low amplitude slow wave can be seen in the bilateral hemisphere.The second-generation gene sequencing found a heterozygous missense mutation of C>T (p.A169v) in the position of chrx-19371287 in the PDHA1 gene of the child, but not in the parent PDHA1 gene.And the diagnosis of pyruvate dehydrogenase E1 α deficiency was identifie.Conclusion:PDHAl mutation-induced pyruvate dehydrogenase E1 α deficiency lacks specificity at an early stage, and female patients are more rare due to random inactivation of the X chromosome.It is necessary to be vigilant against metabolic acidosis in children with unexplained psychomotor retardation, persistent hyperlactemia and difficult to correct.It can be diagnosed by gene analysis.

Objective To investigate the correlation between intra-and peri-tumoral radiomics features and the response to con-current chemoradiotherapy(CCRT)in cervical squamous cell carcinoma,and to explore the difference of predictive performance between 2D and 3D radiomics models.Methods The imaging data of 132 patients were analyzed retrospectively and randomly divided into training set(n=92)and validation set(n=40).Radiomics features were extracted based on the dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI),the correlation analysis and least absolute shrinkage and selection operator(LASSO)algorithm were used for dimensionality reduction and screening,then the radiomics score was calculated and the logistic model was constructed.The receiver operating characteristic(ROC)curve,internal validation of Bootstrap and Brier score were used to evaluate the discrimina-tion and calibration of the model,and the improvement in predictive performance of 3D model compared with 2D model was evaluated by the integrated discrimination improvement(IDI).Results In the training set,the ROC curve showed that the area under the curve(AUC)of the models(2D-intratumoral,3D-intratumoral,3D-peritumoral,3D-combined)ranged from 0.774 to 0.893.The internal validation of Bootstrap showed the AUC were 0.772,0.860,0.847 and 0.888,respectively,while in the validation set,the AUC were 0.757,0.849,0.824 and 0.887,respectively.The Brier scores indicated that the models were well calibrated.In the training set and the validation set,the IDI values were 0.155 and 0.179,respectively,and the differences were statistically significant(P<0.05).Conclusion The radiomics analysis based on the tumor volume can fully explore the tumor heterogeneity.The intra-and peri-tumoral radiomics combined model shows the best predictive performance,which is important to assist clinicians in developing individualized therapies.