Objective To evaluate the diagnostic value of combining real-time three-dimensional ultrasonography with three-dimensional power Doppler ultrasound for the patients with small ovarian masses.Methods One hundred and seven patients with small ovarian masses were examined with real-time three-dimensional ultrasonography and three-dimensional power Doppler ultrasound.The images and the relationship between benign and malignant small ovarian masses were analyzed.Results Benign and malignant small ovarian tumors had statistical differences in these three parameters:the envelope,inner wall and whether there being central vessels.The sensitivity and specificity of combining real-time threedimensional ultrasonography with three-dimensional power Doppler ultrasound to diagnose malignant small ovarian tumors were 92.9% and 97.3% respectively.Conclusions Combining real-time three-dimensional ultrasonography with three-dimensional color Doppler energy can be used to diagnose the small ovarian masses and provide valuable information to identify malignant ovarian tumors.A small ovarian tumor with incomplete envelope,irregular inner wall and there being central vessels indicated the possibility of being malignant.

Objective To introduce our experience in embolizing cerebral ruptured-aneurysms of elderly patients in our hospital. Methods Totally 76 elderly patients were referred to our hospital due to ruptured-aneurysms.81 aneurysms were confirmed by DSA,all of them were sac aneurysms,among which 75 cases (body/neck≥ 1) were treated with balloon-assisted coiling,29 narrow-necked (body/neck≥2) aneurysms and 30 wide-necked (1 ≤ body/neck＜ 2) aneurysms were treated with balloon-assisted coiling successfully,but 6 narrow-necked (body/neck≥2) were treated with balloonassisted coiling in emergency,followed by a stent-assisted coiling in secondary embolization,4 cases with body/neck＜1 were treated with stent-assisted coiling technique in emergency,2 non ruptured aneurysms could not be treated.The times of balloon dilation were (2.1 ± 1.3),single expansion of filling was (33.4±14.1)s. Results The arterial thrombosis happened in two patients (2.7 ％),two aneurysms ruptured (5.3％) during the procedure. No stent-related thrombosis happened. 86were elevated as good,8 as serious according to the Glasgow outcome scale,neither died after operation or delayed thrombosis or infarction lesion during following up. Conclusions Balloonassisted coiling is a safe and effective method in elderly patients during acute stage of rupturedaneurysms.

To reflect specialty teaching characteristics and levels in clinical standardized training of medical professional degree postgraduates and highlight the thinking of evidence-based medicine culture,in urology rotation training practice,we conducted clinical pathway teaching according to picot principle (PICOT-CP teaching).According to the requirements of the teaching syllabus,the six kinds of major diseases were brought into PICOT-CP teaching.After the screening of pre teacher training,teaching tools and teaching cases,and based on the form of PICOT-CP,we standardized the implementation of clinical teaching of Urology,fully used subject website platform to discuss the interaction between teachers and students,and assessed the effect in combination with the departmental rotation examination and the teaching questionnaire survey of the students and the training teachers.Preliminary practice shows that PICOT-CP teaching helps to stimulate students' interest in learning,improve their overall quality,expand their clinical thinking,and establish their concept of evidence-based medicine.In addition,PICOT-CP teaching is beneficial to the teaching norms of teachers' teaching and can improve teaching level.

Objective To explore the therapeutic strategy for intracranial ischemia due to extraand intracranial artery stenosis using endovascular stent angioplasty.Methods Totally 109 patients with extra-and/or intracranial artery stenosis were treated by endovascular stent in our hospital from March 2008 to September 2011.There were 93 cases with single stenostic lesion,16 cases with multiple stenosis and 5 cases with distal unruptured aneurysm.All patients received endovascular stentings and 94 cases were followed up for 3 20 months.Results All of the patients underwent endovascular stenting placement successfully.The average stenosises were(79.2 ± 13.4)％ before operation and(18.1 ± 9.20)％ after operation.During follow-up for(10.8 ± 4.2)months,mild restenosis occurred in 9 stenosises(7.0％)among 129 lesions and no serious stroke event was found.Conclusions Endovascular stent is safe and effective in treating extra and intracranial stenosis.It is important to investigate adequately cerebral blood flow in the multiple stenosis or in complicating other kind of vascular diseases before proper treatments.

Objective To analyse the effect of holmium laser incision through ureteroscopy and simple ureteroscopy treatment for refrac-tory hemospermia. Methods From December 2003 to April 2013,the data of 67 cases with refractory hemospermia were retrospectively ana-lyzed. All the patients underwent semen analysis,transrectal ultrasonography,seminal vesicle ultrasonography,some patients underwent pelvic CT or MRI. Results Simple ureteroscopy were done for 24 cases,holmium laser incision through ureteroscopy were done for 43 cases. Var-ying degrees of ejaculatory duct stenosis or obstruction were observed. Postoperative follow-up was from 6 months to 8 years,in 24 cases of simple ureteroscopy,2 cases experienced recurrence 6 or 8 months later. The ejaculatory duct narrow were found when they received reopera-tion,with holmium laser incision,hemospermia disappeared. No complications such as retrograde ejaculation,urinary incontinence or rectal injury occurred postoperatively. Conclusion The effect of holmium laser incision through ureteroscopy for refractory hemospermia is better than simple ureteroscopy,which is worthy of clinical application needs further observation and summary.

Objective To study the relationship between cardiovascular diseases (CVD)and 24-h peritoneal protein losses (PPL) in continuous ambulatory peritoneal dialysis (CAPD)patients. Methods One hundred and seventy-eight CAPD patients in our department were enrolled in this study. Their 24-h PPL was measured and other clinical data were recorded at the beginning. Meanwhile, Doppler ultrasound examination was performed. They were then followed-up prospectively for the development of CVD. Results The average of 24-h PPL was (5.0±1.8) g.Patients with diabetic status or preexisting CVD or carotid arteries arteriosclerosis had higher 24-h PPL than those without (t=2.082, P=0.039; t=2.601, P=0.010; t=2.217, P=0.029). 24-h PPL was positively correlated with left ventricular end-diastolic diameter (LVDd), interventricular septal thickness (IVSTd), posterior wall diameter of left ventricle at end-diastolic (LVPWd) and left ventricular mass index (LVMI) (r=0.222, P=0.040; r=0.217, P=0.043; r=0.339, P=0.002; r=0.305, P=0.007). It was negatively correlated with ejection fraction of left ventricle (r=0.221, P=0.040). One hundred and fourteen CAPD patients were prospectively followed-up for at least twelve months. Patients developing CVD were 40.4% and 19.3% for high and low PPL groups respectively (x2=6.035, P=0.014). In the multivariable logistic regression analysis, the 24-h PPL was one of the independent factors for developing CVD. Conclusions There is a significant and independent relationship between 24-h PPL and new cardiovascular events. 24-h PPL may be an important predictor of cardiovascular disease.

Objective To investigate the distribution of in-stent recurrent stenosis (1RS) after balloon-angioplasty and stenting in elderly cerebral ischemic patient and its correlative factors.Methods Totally 158 elderly cerebral ischemic patients with extra-and/or intracranial artery stenosis were treated with 172 stents in our hospital.The inhibition of platelet function was assessed by using the thrombus elasticity chart system in perioperative period,and the anti-platelet agents were adjusted correspondingly.150 patients were followed up by digital subtraction angiography (DSA) and the other 8 patients were followed up by CT angiography,during an average follow-up duration of 8.3 months.Results There were 11 (6.4％) IRS lesions,among which 10 lesions were at the vertebral artery origin and 1 lesion was at common carotid artery bifurcation.23.8％ of IRS happened after vertebral artery origin stenting,and all in-stent recurrent stenosis were in the origin of non-dominant vertebral artery,whose IRS rate was 66.7％.Conclusions IRS are more common found in vertebral artery origin than in other parts of vertebral artery and are more common found in nondominant side than in dominant side.

Objective To reveal the chromosome abnormalities and their relationship with the clinical phenotype of neonates with congenital malformation.Methods Karyotype analysis of peripheral blood lymphocytes was performed on 396 newborns with congenital malformation,who were recruited at the Children's Hospital Affiliated to Soochow University from Jan.2006 to May 2012,chromosome karyotypes were prepared with neonatal peripheral lymphocytes by conventional G-banding technique.Results 1.Of 396 newborns,159 (40.2％) cases were detected to have chromosomal abnormalities,including karyotype first reported domestically and internationally in 3 cases.2.Trisomy-21 (Down's syndrome),which was the most common abnormal karyotype,was seen in 130 cases,accounting for 81.8％,of whom 119 cases show the standard type,10 cases accompanied by the Robertsonian translocation involving group D or group G,and 1 case accompanied by sexual chromosomal abnormality:inv(Y) (p1 1 q 1 1),+ 21.3.Other common karyotype abnormalities were as follows:del (5) (p 1 2-14) (cats cry syndrome) in 4 cases,trisomy-18 (Edwards syndrome)in 4 cases,45,XO (Turner' s syndrome) in 4 cases,inv (9) (p1 1 q1 2-21) in 4 cases,trisomy-X (super female syndrome) in 1 case,rob(13;14) in 1 case,trisomy-8 in 1 case and del(18) (q22) in 1 case.4.Special faces were seen in 147 cases (92.5 ％),congenital heart disease in 97 cases (61.0％),low birth weight in 72 cases (45.3 ％),congenital anal atresia in 13 cases(8.1％),multiple malformations in 11 cases (6.8％),intestinal malformations in 10 cases (6.2％),extrinsic genital abnormalities in 9 cases(5.7％),meow-like cry in 4 cases(2.5％),limb edema in 4 cases (2.5％),fingers and toe abnormalities in 6 cases(3.6％),congenital brain dysplasia in 6 cases (3.6％),webbed neck in 5 cases(3.1％) and cleft lip and palate in 3 cases(1.8％).Conclusions Chromosomal abnormality is an important factor leading to neonatal birth defects,of which special face,congenital heart disease,low birth weight,and multiple malformations are the main clinical manifestations of chromosomal diseases.

Objective To report two childhood acute myeloid leukemia (AML) patients with t(8;20)(q22;q13) and t(1;8;21)(q32;q22;q22) respectively,as variant t(8；21).Methods Chromosome preparation of bone marrow cells were made using short-term culture and karyotypic analysis was carried out using R and G-banding techniques.Interphase-fluorescence in situ hybridization (I-FISH) and metaphase-FISH (M-FISH) were performed using dual color,dual fusion AML1-ETO probe to detect the AML1-ETO fusion gene.Multiplex RT-PCR was used to demonstrate the expression of AML1-ETO fusion transcript.Results The karyotype of bone marrow cells for these two childhood AML patients were 45,X,-Y,t(8;20)(q22;q13)[12]/46,XY[3](case 1) and 46,XX,t(1;8;21)(q32；q22;q22)[18]/46,XX[2](case 2),respectively.I-FISH and M-FISH confirmed that they all had the AML1-ETO fusion gene and variant t(8;21).The AML1-ETO fusion transcript in both patients was detected by RT-PCR.Conclusion t (8;20)(q22;q13) and t (1;8;21)(q32;q22;q22) are variant t (8;21) in nature.It is important to combine the conventional karyotypic analysis with D-FISH and multiplex RT-PCR to determine the nature and prognosis of AML patients with variant t(8;21).

Background MMPs and TIMPs play important roles in tumor angiogenesis and invasion.Studies have shown that TIMP-2 has two roles in tumor invasion.However,its role in leukemic infiltration has not been well investigated.This study explored the roles of TIMP-2 in extramedullary infiltration of acute monocytic leukemic SHI-1 cells both in vitro and in vitro.Methods A retroviral vector carrying the human TIMP-2 cDNA was constructed and transfected into the monocytic leukemic cell line SHI-1.The expression of TIMP-2 in the positive clones was determined.The proliferation of SHI-1 cells was examined by MTT assay.Trans-Matrigel invasion assays were used to investigate the infiltration ability in vitro.SHI-1 cells were intravenously injected into pre-treated nu/nu mice to investigate the infiltration ability feature in vitro.Results The expression of TIMP-2 on the cell membrane was significantly elevated in SHI-1/TIMP-2 cells.Over-expression of TIMP-2 promoted the cells proliferation and the invasions in vitro.The SHI-1/TIMP-2 cells demonstrated higher infiltration ability when intravenously injected into nu/nu mice.Conclusion Over-expression of TIMP-2,especially on the cell membrane,may play important roles in promoting the proliferation and infiltration of SHI-1 leukemic cells.