Objective To process the image of endoscopic uhrasonography(EUS)by digital imaging processing(DIP)and pattem recognition,and to evaluate its efficacy in diagnosis of pancreatic adenocarcinoma.Methods Two hundreds and sixteen patients,who underwent EUS between Feb 2005 and Feb 2007,were randomly recruited to the study.The cohort jncluded 153 cases of pancreatic cancer,which were confirmed by cytological findings after fine-needle aspiration,and 63 cases of non-pancreatic cancer(normal pancreas and chronic panereatitis).The texture features of the EUS image were selected and extracted,and cases were automatically divided into cancer and non-cancer based on findings of support vector machine (SVM).Sensitivity,specificity and accuracy of the technique were calculated.Results From each region of interest(ROI),a total of69 texture features vest in 9 sets were extracted,and 25 features with most set interval were taken as initial.The images of 216 cases were divided randomly into training set(108 eases,76 cancer and 32 non cancer)and testing set(108 cases,77 cancer and 31 non cancer).After 50 times of random tests,the average accuracy,sensitivity and specificity of the diagnosis of pancreatic cancer were (97.98±1.237)%,(94.32±0.0354)%,and(99.45±0.0102)%respectively.Conclusion DIP,combined with computer aided EUS imaging,is an accurate and noninvasive technique in diagnosis of pancreatic cancer.which warrants novel and further researches.

Objective To develop and evaluate the digital discrimination system for pancreatic ultrasound endoscopy images. Methods EUS images of 153 pancreatic cancer and 63 non-cancer cases were selected. According to the multi-fractal feature vectors based on the M-band wavelet transform, we acquired the fractal features with lower dimension with the feature screening algorithm. With the optimal feature combination, cases were classified into pancreatic cancer group and non-pancreatic cancer group automatically.Then the sensitivity, specificity and accuracy of this method were calculated, and compared with those of traditional 9 dimension fractal feature vectors. Results Three kinds of multi-fractal dimensions were introduced to the framework of M-band wavelet transform according to the EUS images to form fractal vectors of 18 dimension. With the selection by sequence forward search (SFS) algorithm, 7 dimension of feature vectors were chosen and were combined with bi-order multi-fractal dimension to a better feature combination. The Bayes, support vector machine (SVM) and ModestAdaBoost classifiers were introduced to evaluate the classification efficiency, resulting in a classification accuracy of 97.98% and short running time of 0. 49 s with lower feature dimension. Conclusion These data suggest the feasibility, accuracy, noninvasiveness and efficacy of classification of EUS images to differentiate pancreatic cancer from normal tissue based on the Mband wavelet transform algorithm. It is a new and valuable research area in diagnosis of pancreatic cancer.

Objective To compare the clinical curative effect between laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in treatment of terminal bile duct carcinoma.Methods Clincal data of 40 patients with advanced terminal bile duct carcinoma who underwent pancreaticoduodenectomy in our hospital from March 2008 to March 2013 were collected,of which 12 patients were in LPD group and 28 patients in OPD group.Results Hospitalization expense and operative time of patients were in LPD group were both more or longer than those of OPD group (P ＜ 0.05),but haemorrhage,pulling out the drainage tube time,pulling out the stomach tube time,active time post-operation,aeration time,absolute resting on bed time,and hospitalization time in LPD group were lower or shorter than those of OPD group (P ＜ 0.05).There were 15 patients suffered with postoperative complication,including 5 patients in LPD group and 10 patients in OPD group,and there was no significant difference between the two groups in total incidence of postoperative complication (P ＞ 0.05).In the specific postoperative complication,the incidences of biliary fistula of LPD group were higher than those of OPD group (P ＜ 0.05),but incidences of pancreatic fistula,systemic infection,pulmonary infection,incision infection,and delayed gastric emptying between two groups were no significant difference (P ＞ 0.05).All patients were followed up for 1-36 months with the median time of 27 months.During the follow-up periods,in LPD group,8 patients suffered with recurrence,6 patients suffered with tumor metastasis,and 8 patients died;in OPD group,18 patients suffered with recurrence,13 patients suffered with tumor metastasis,and 18 patients died.There were no significant difference between two groups in the recurrence rate,metastasis rate,and mortality (P ＞ 0.05).Conclusion According to the results of the current study,for patients with common bile duct cancer,LPD group was superior to OPD group in the postoperative recovery.But compared with OPD group,it had no obvious advantage in reducing biliary fistula,pancreatic fistula,infection,delayed gastric emptying,and so on,and it also had no obvious advantage in improving the long-term survival situation.However,due to the relatively small sample size of the two groups,the results of this study may lead to some bias,the curative effect of two kinds of surgical comparison still need more clinical research to further explore.

With the rapid development of contrast-enhanced ultrasound(CEUS),Sonazoid,a new generation of ultrasound microbubbles contrast agent came into being.The unique Kupffer phase of Sonazoid could greatly prolong the intrahepatic developing time,hence providing more valuable information for diagnosis,treatment and follow-up of liver diseases.The progresses of Sonazoid applicated in liver diseases were reviewed in this article.

Objective To understand the mutual relation of general self-efficiency and high quality care among clinical nurses .Methods Using the General Self-Efficiency Scale ( GSES) and the quality nursing care brief questionnaire , we surveyed 120 nurses selected from a hospital in Xiamen .Results The mean score of GSES was (2.41 ±0.82), which was lower than the norm score of (2.95 ±0.53).The difference was significant (t=-4.385,P<0.05).The mean score of quality nursing care brief questionnaire was (94.84 ± 12.49).Nurses, with different age, titles and working years, had significant differences in the score of GSES (t=4.464, 2.55, 2.89, respectively;P<0.05).There was a positive relationship between nurses ’ general self-efficacy and high quality care (r =0.245,P<0.05).Multiple linear regression analysis revealed that attitude towards work , technical ability and timely operation were the influencing factors of nurses ’ general self-efficacy scores .Conclusions The general self-efficacy of nurses should be improved .Nursing administrators should pay attention to nurses ’ general self-efficacy and encourage them to adopt active communication skills , and strengthen their conviction and take some measures , such as increasing propaganda , clearing the meaning of high quality care , so as to promote the development of nursing staff .

Objective:To explore the clinical effect of modified urethral anastomosis in penile reconstruction for female-to-male(FTM) transsexuals.Methods:A retrospective analysis was performed on the FTM transsexuals undergoing penile and urethral reconstruction in Second Affiliated Hospital of Naval Medical University from December 2016 to December 2020. In this method, lower abdominal flap and anterolateral thigh (ALT) flap were used to reconstruct the neophallus, and vaginal mucosa was used to reconstruct the urethra step by step. The 2 stage procedure was divided into 3 stage. During the second stage operation, a 2 cm wide flap bridge was reserved near the perineal end of the prefabricated urethral opening, which separated the prefabricated urethral from the urethra reserved at the pubic area. And the third stage urethral anastomosis was performed 6 months later. The urethral function after penile reconstruction was followed up to observe whether the patients had urinary fistula, standing urination and urethral patency.Results:A total of 6 FTM transsexuals, aged 29-40 years, were enrolled in the study. The operation was successful. Among them, the right ALT flap was used in 4 cases, and the left lower abdominal flap was used in 2 cases. In one case, partial flap necrosis was found in the distal part of the penis one week after the second stage surgery, which healed with free skin grafting after 2 weeks. During postoperative follow-up of 10-30 months, no urinary fistula occurred and all patients were able to urinate standing up, with no urethral stricture.Conclusions:The urethra was prefabricated with a lower abdominal flap or ALT flap, and then the procedure of phalloplasty and modified urethral anastomosis was performed in stages, which could reduce the incidence of urinary fistula and urethral stricture in FTM transsexuals.

The growth of puberty height is affected by many factors, among which the role of sex hormones is particularly important. The height increase in puberty accounts for about 20% of the final height in adulthood. It was previously believed that the final height of patients with disorders of sexual development was impaired due to the disorder of sex hormones. However, there are more classifications and subtypes of disorders of sexual development, and the growth patterns of patients with different subtypes of disorders of sexual development are also different. This article briefly reviews puberty bone growth, the effect of sex hormones on puberty bones, the sex hormone spectrum and growth pattern of patients with common disorders of sexual development, and the effect of growth hormone therapy.

The growth of puberty height is affected by many factors, among which the role of sex hormones is particularly important. The height increase in puberty accounts for about 20% of the final height in adulthood. It was previously believed that the final height of patients with disorders of sexual development was impaired due to the disorder of sex hormones. However, there are more classifications and subtypes of disorders of sexual development, and the growth patterns of patients with different subtypes of disorders of sexual development are also different. This article briefly reviews puberty bone growth, the effect of sex hormones on puberty bones, the sex hormone spectrum and growth pattern of patients with common disorders of sexual development, and the effect of growth hormone therapy.

Objective:To explore the clinical effect of modified urethral anastomosis in penile reconstruction for female-to-male(FTM) transsexuals.Methods:A retrospective analysis was performed on the FTM transsexuals undergoing penile and urethral reconstruction in Second Affiliated Hospital of Naval Medical University from December 2016 to December 2020. In this method, lower abdominal flap and anterolateral thigh (ALT) flap were used to reconstruct the neophallus, and vaginal mucosa was used to reconstruct the urethra step by step. The 2 stage procedure was divided into 3 stage. During the second stage operation, a 2 cm wide flap bridge was reserved near the perineal end of the prefabricated urethral opening, which separated the prefabricated urethral from the urethra reserved at the pubic area. And the third stage urethral anastomosis was performed 6 months later. The urethral function after penile reconstruction was followed up to observe whether the patients had urinary fistula, standing urination and urethral patency.Results:A total of 6 FTM transsexuals, aged 29-40 years, were enrolled in the study. The operation was successful. Among them, the right ALT flap was used in 4 cases, and the left lower abdominal flap was used in 2 cases. In one case, partial flap necrosis was found in the distal part of the penis one week after the second stage surgery, which healed with free skin grafting after 2 weeks. During postoperative follow-up of 10-30 months, no urinary fistula occurred and all patients were able to urinate standing up, with no urethral stricture.Conclusions:The urethra was prefabricated with a lower abdominal flap or ALT flap, and then the procedure of phalloplasty and modified urethral anastomosis was performed in stages, which could reduce the incidence of urinary fistula and urethral stricture in FTM transsexuals.

Objective To observe the correlations of conventional ultrasound and contrast-enhanced ultrasound(CEUS)features with expression level of Ki-67 of intrahepatic cholangiocarcinoma(ICC).Methods A total of 77 patients with pathologically confirmed ICC were retrospectively enrolled.According to the expression level of Ki-67 of target lesions,the patients were divided into high expression group(Ki-67≥20%,n=53)and low expression group(Ki-67＜20%,n=24).The features showed on conventional ultrasound and CEUS were compared between groups,and the variables being significantly different were analyzed with multivariate logistic regression to select ultrasonic features being correlated with Ki-67 expression level of ICC.Results The mean maximum diameter of ICC in high expression group was larger than that in low expression group([6.2±2.0]cm vs.[5.2±1.9]cm,P=0.041),and the percentage of ICC with maximum diameter>5 cm in high expression group was higher than that in low expression group(66.04%vs.33.33%,P=0.007).No significant difference of the lesions shape,border nor the internal echogenicity showed on conventional ultrasound was found between groups(all P＞0.05).The percentage of ICC with peripheral rim enhancement and enlargement after enhancement in high expression group were both higher than those in low expression group(both P＜0.05),but no significant difference of the enhancement pattern,the presence or absence of non-enhance area within the lesion nor the peak intensity of lesions was found between groups(all P＞0.05).The maximum diameter larger than 5 cm(OR=5.612,P=0.004)and peripheral rim enhancement(OR=3.880,P=0.025)were both independent factors for predicting high Ki-67 expression level of ICC.Conclusion ICC with the maximum diameter larger than 5 cm and peripheral rim enhancement on CEUS might indicate high expression level of Ki-67,which was helpful for clinical treatment decisions.