Objective:To investigate the clinical efficacy of qualitative and staging diagnosis of rectal tumors with dual contrast-enhanced ultrasonography and interventional biopsy.Methods:A total of 300 patients with rectal tumors who received treatment in The First People's Hospital of Huzhou from December 2019 to March 2022 were included in this study. All patients underwent dual contrast-enhanced ultrasonography and interventional biopsy followed by focus resection. Taking the postoperative histopathological test results as the gold standard, the efficacy of dual contrast-enhanced ultrasonography and interventional biopsy in the localization, qualitative analysis, and staging of rectal tumors was analyzed.Results:The compliance rate of dual contrast-enhanced ultrasonography and interventional biopsy in the localization of rectal tumors was 100%. The sensitivity, specificity, and accuracy of the dual contrast-enhanced ultrasonography and interventional biopsy for qualitative diagnosis of rectal tumors were 94.8%, 97.8%, and 96.7%, respectively. The Kappa value used for assessing agreement in the qualitative diagnosis of rectal tumors between dual contrast-enhanced ultrasonography and interventional biopsy and postoperative tissue pathological examination results was 0.947. The area under the curve plotted for qualitative diagnosis of rectal tumors was 0.974. The sensitivity, specificity, and sensitivity of dual contrast-enhanced ultrasonography and interventional biopsy for diagnosis of stage I-III rectal cancer were 94.1%-97.8%. The Kappa values used for assessing agreement in staging diagnosis of stage I-III rectal cancer between dual contrast-enhanced ultrasonography and interventional biopsy and postoperative tissue pathological examination results were 0.923, 0.912, and 0.927, respectively. The areas under the curve plotted for staging diagnosis of rectal cancer were 0.961, 0.955, and 0.970, respectively.Conclusion:Dual contrast-enhanced ultrasonography and interventional biopsy have a high efficacy in the localization, qualitative diagnosis, and staging diagnosis of rectal tumors.

Objective:To correlate diaphragmatic ultrasound parameters and pulmonary function in patients with chronic obstructive pulmonary disease (COPD) and its clinical value in the diagnosis of COPD.Methods:Eighty patients with COPD who received treatment in The First People's Hospital of Huzhou from January 2019 to June 2020 and 80 healthy subjects who concurrently received health examination were included in this study. Pulmonary function index, diaphragmatic ultrasonic parameters and activity endurance index were compared between COPD group and healthy control group. Diaphragmatic ultrasound parameters in COPD patients were correlated with pulmonary function index and activity endurance index.Results:The forced expiratory volume in 1 second/forced vital capacity (FEV 1/FVC) ratio in the COPD group was significantly lower than that in the healthy control group [(56.27 ± 8.98)% vs. (87.42 ± 6.29)%, t = 14.583, P < 0.05]. The residual volume/total lung capacity (RV/TLC) ratio in the COPD group was significantly higher than that in the healthy control group [(54.81 ± 6.95) % vs. (27.59 ± 3.92) %, t = 17.904, P < 0.05]. The walking distance in 6-minute walking test (6MWT) in the COPD group was significantly shorter than that in the healthy control group [(502.36 ± 82.41) m vs. (824.59 ± 63.37) m, t = 11.726, P < 0.05]. The diaphragm mobility using quite breathing (DM QB), the diaphragm mobility using deep breathing (DM DB), and diaphragmatic thickening fractions (TF) in the COPD group were (1.71 ± 0.45) mm, (4.03 ± 0.81) m and (117.56 ± 24.83) %, respectively, which were significantly lower than those in the healthy control groups [(2.24 ± 0.30) mm, (5.36 ± 0.62 ) mm, (159.60 ± 22.35)%, t = 4.736-7.592, all P < 0.05]. DM QB, DM DB and TF in patients with COPD were positively correlated with FEV 1/FVC and 6MWT distance ( r = 0.705-0.819, all P < 0.05), but they were negatively correlated with residual volume/total lung capacity (RV/TLC) ratio ( r = -0.774 to -0.847, all P < 0.05). Conclusions:DM QB, DM DB and TF decrease in COPD patients, and their values are correlated with pulmonary function and activity tolerance index. Ultrasound examination of diaphragmatic morphological change is of certain clinical value for the diagnosis and evaluation of COPD.

Objective:To observe the clinical effect of pelvic floor ultrasound in the diagnosis and rehabilitation training of postpartum stress urinary incontinence(SUI).Methods:From May 2017 to May 2019, 200 SUI patients and 200 healthy pregnant women in the same period admitted to the First People's Hospital of Huzhou were selected in this study.All the subjects were tested by perineum and pelvic floor ultrasound, and the patients with SUI were instructed to carry out pelvic floor muscle rehabilitation training, the level of rehabilitation training effect was evaluated, and to statistically analyze the difference of pelvic floor ultrasound parameters between the patients with SUI and the healthy women, and the patients with different levels of efficacy.Results:The results of pelvic floor ultrasound in SUI patients were significantly higher than those in healthy women( t=6.536-14.925, all P<0.05). The rate of urinary leakage in SUI patients [88.50%(177/200)] was significantly higher than that in healthy women [10.50%(21/200)](χ 2=243.384, P<0.05). The total effective rate of rehabilitation training was 79.50%(159/200). The bladder neck moving distance, urethra rotation angle, posterior angle of bladder urethra in resting state and posterior angle of bladder urethra in Valsalva state in SUI patients with ineffective rehabilitation training were significantly higher than those in SUI patients with general effective rehabilitation training( t=4.662-12.537, all P<0.05). The formation rate of urethra infundibulum in SUI patients with ineffective rehabilitation training [70.73%(29/41)] was significantly higher than that in SUI patients with effective rehabilitation training [19.50%(31/159)](χ 2=40.744, P<0.05). Conclusion:The rehabilitation training of discoid muscles can effectively relieve the related clinical symptoms of postnatal SUI patients.The detection of pelvic ultrasound has a certain clinical value in the diagnosis of postpartum SUI and evaluation of rehabilitation training effect.

Objective:To investigate the clinical feature, diagnosis, treatment and prognosis of childhood acute lymphoblastic leukemia (ALL) complicated with candida tropicalis bloodstream infection (CTBI), so as to improve the understanding of this disease.Methods:The general information, clinical manifestation, auxiliary examination, treatment and outcome of 14 childhood ALL who were diagnosed with tropical candidemia between January 2015 and December 2018 in 6 hospitals were analyzed retrospectively. Clinical data of non invasive fungal disease (IFD) ALL (28 cases) and other IFD children (9 cases) admitted in the same period were collected as control group. Logistic regression model was used to analyze the risk factor of CTBI.Results:Among 14 cases, there were 7 males and 7 females, with the age ranged from 17 months to 13 years. All the cases had fever, 9 cases had digestive system symptoms and stool fungal culture were positive in 3 of them; 7 cases had respiratory system symptoms and sputum fungal culture was positive in 1 of them; 2 cases had central nervous system symptoms and 10 cases progressed into septic shock. All 14 cases had neutropenia and the neutropenia duration was 1 to 53 days. Among 14 cases, the C-reactive protein was>50 mg/L in 8 cases, in which the proportion was significantly higher than that in other invasive fungal disease(IFD) (8/14 vs. 1/9, P<0.05), meanwhile the 1, 3-β-D-glucan detection, galactomannan detection and pulmonary imaging were not remarkable in all 14 cases. The blood culture results of 14 cases were all candida tropicalis, among which 13 cases finished drug susceptibility tests, the isolates of all cases were sensitive to flucytosine and amphotericin B, and the isolates of 4 cases were sensitive to fluconazole, voriconazole and itraconazole. Among 14 cases, 1 case lost to follow-up after giving up treatment, 1 case died before antifungal therapy and the remaining 12 cases received antifungal therapy; 7 of the 14 cases died. Univariate analysis showed that between ALL with CTBI group (14 cases) and ALL without invasive fungal disease (IFD) group (28 cases), the differences in variables such as ALL not in remission (χ2=37.847, P<0.01), length of hospital stay>15 days (χ 2=8.351, P=0.004), neutropenia (χ2=14.280, P<0.01), neutropenia duratio n>10 days (χ2=10.254, P=0.001), use of broad-spectrum antibiotics (χ2=13.888, P<0.01), skin and mucous membrane damage (χ2= 5.923, P=0.015) were statistically significant. Conclusions:In childhood ALL complicated with tropical candidemia, the drug resistance rate and mortality rate were high. For azole-resistant tropical candida, amphotericin B liposome or echinocandins(caspofungin) -fluorocytosine combined therapy was recommended to reduce treatment-related deaths.

Objective To explore the value of contrast-enhanced ultrasound (CEUS) and intraluminal contrast in the differential diagnosis of postmenopausal endometrial benign and malignant lesions.Methods The ultrasound data of 90 patients with postmenopausal endometrial lesions diagnosed in our hospital between March 2016 and March 2018 were retrospectively analyzed.According to pathological findings,they were divided into benign group (55 cases) and malignant group (35 cases).The endometrial thickness of endovascular contrast,rise time (RT),time to peak (TTP),base intensity (BI),and peak intensity (PI) of CEUS in two groups were compared.Receiver operating characteristic curves (ROC) were used to compare the efficacy of different ultrasound parameters in benign and malignant endometrial by using pathology diagnosis as "gold standard".Results The endometrial thickness and PI were significantly higher in the malignant group than those in the benign group (P ＜ 0.05),while the RT and TTP were significantly lower than benign group (P ＜ 0.05),with no statistical difference in BI (P ＞ 0.05).The ROC curve showed that PI has the highest area under curve (AUC) in the differential diagnosis of benign and malignant endometrial lesions (AUC =0.983),followed by RT and TTP (AUC =0.889,0.872),and intimal thickness (AUC =0.766).AUC of PI was significantly higher than RT,TTP and intimal thickness (P ＜ 0.05),and the best cut-off point for PI ≥20.23 dB.The sensitivity of PI,RT,and TTP in differentiating benign and malignant endometrial lesions was significantly higher than that in intimal thickness (P ＜ 0.05),whereas the specificity and positive likelihood ratio (+ LR) of PI were significantly higher than those of RT,TTP,and intimal thickness (P ＜ 0.05).Conclusions Compared with intracavitary ultrasound,CEUS has better diagnostic value in differentiating benign and malignant endometrial tumors.Among them,the diagnostic sensitivity and specificity of PI≥20.23 dB are higher.

Objective To provide a suggestion for physicians participating clinical research of how to write a clinical trial protocol correctly and standardly in the course of clinical trial design.Methods By exploring clinical trial protocols,we analyzed their common problems in the methodological details and the reporting standards with respect to typical cases.Results The common problems in the clinical trial protocols are:lack of clear outline when selecting the research subject;incorrect selection of research type;lack of comprehensiveness and accuracy of PICO elements;inappropriate application of methodologies in randomization and blinding;absence of statistical analysis plan;incorrect calculation of sample size;non-standard format of the protocol etc.Conclusions Many clinicans do not have enough understanding of the key points in designing the clinical trial and writing the protocol.However,the quality of the clinical trial protocol determines success or failure of the whole study.Therefore,carefully handling the technical details of PICO elements,methodology and statistics application,and writing the protocol in accordance with the CONSORT (Consolidated Standards of Reporring Trials) 2010 and SPIRIT (Standard Protocol Items:Recommendations for Interventional Trials)2013 Statements,are the key points that each clinical researcher should pay attention to.

Objective To observe the expression of cAMP -response element binding protein (CREB) and N-methyl-D-aspartic acid receptor (NMDA ) after intracochlear electrical stimulation in the auditory cortex and inferior colliculus in infant rats with auditory deprivation .Methods Sixty six SD infant rats were randomly divided into 6 groups (11 rats each group):4 weeks ,and 6 weeks after injection of ototoxic drug ,the control group ,and 3 weeks and 5 weeks after injection of ototoxic drug with intra -cochlear electrical stimulation for one week .Gentami-cin sulphate (350 mg/kg body weight) and frusemide (200 mg/kg body weight) were injected subcutaneously in the skin folds on the lateral abdominal side and the dorsal neck area ,respectively .The expression of CREB and NMDAR1protein were detected by immunohistological staining .Results The results of immunohisto -chemistry revealed that protein expression of CREB and NMDAR1 in 4 week group of injection increased as compared to the control group ,while decreasing as compared to intracochlear electrical stimulation group ,significantly .However ,protein expression of CREB and NMDAR1 in 6 week group of injection decreased as compared to the control group and in-tracochlear electrical stimulation group ,significantly .Conclusion Auditory deprivation could result in the expres-sion of protein of CREB and NMDAR1 in auditory cortex and inferior colliculus increasing in an early stage and then de-creasing in infant rats .Intracochlear electrical stimulation could result in the expression of proteins of CREB and NMDAR 1 in auditory cortex and inferior colliculus increasing in infant rats .The dynamic variation of CREB and NMDAR1 expression in rat auditory cortex and inferior colliculus reflects synaptic plasticity in neurons of auditory pathway .

Objective To explore the prognostic factors of portal hypertension treated with devascularization.Methods A total of 397 patients with portal hypertension underwent devascularization in Nanjing Drum Tower Hospital from February 1993 to April 2014,among which there were 242 male and155 female patients with median age of 48 years.The perioperative data were retrospectively collected.Logistic regression was used to find the risk factors which affect the operative complications.Follow-up evaluation was in progress regularly.Kaplan-Meier survival curve,Log-rank test and Cox regression model were used to find out factors which affect the long-term results.Results All together 397 patients underwent devascularization,in whom 8 patients died perioperative,389 patients discharged successfully.Logistic regression showed that age (≥ 48 years) (X2 =4.559,OR =2.048,P =0.033),red color sign before surgery (x2 =4.959,OR =2.129,P =0.026) and without portosystemic collateral vessels reserved (x2 =13.348,OR =5.122,P =0.000) were risk factors of perioperative complications.The follow-up time was (5.7±4.6) years.Totally 27 patients were lost from follow-up,103 patients died for the disease during follow-up.The survival rate at 1-,3-,5-,10-,15-and 20-years was 93.6％,86.9％,80.1％,59.3％,54.1％ and 38.5％ respectively.Univariate analysis showed that gender (male),age (≥ 48 years),hemorrhage before surgery (≥500 ml per time),hepatitis virus and without portosystemic collateral vessels reserved were risk factors of the long-term survival (P ＜ 0.05).Cox regression analysis showed that age (≥48 years) (X2 =9.850,RR =1.904,P =0.002),hemorrhage before surgery (≥ 500 ml per time)(X2 =34.402,RR =3.273,P =0.000),hepatitis virus (X2 =7.573,RR =2.525,P =0.006) and without portosystemic collateral vessels reserved (x2 =5.905,RR =１.889,P =0.015) were independent risk factors that affect the long-term survival.Conclusion Devascularization with portosystemic collateral vessels reserved has favorable perioperative and long-term outcome,and it definitely is a very safe and effective technique for portal hypertension.

Objective To explore the prognostic factors of portal hypertension treated with devascularization.Methods A total of 397 patients with portal hypertension underwent devascularization in Nanjing Drum Tower Hospital from February 1993 to April 2014,among which there were 242 male and155 female patients with median age of 48 years.The perioperative data were retrospectively collected.Logistic regression was used to find the risk factors which affect the operative complications.Follow-up evaluation was in progress regularly.Kaplan-Meier survival curve,Log-rank test and Cox regression model were used to find out factors which affect the long-term results.Results All together 397 patients underwent devascularization,in whom 8 patients died perioperative,389 patients discharged successfully.Logistic regression showed that age (≥ 48 years) (X2 =4.559,OR =2.048,P =0.033),red color sign before surgery (x2 =4.959,OR =2.129,P =0.026) and without portosystemic collateral vessels reserved (x2 =13.348,OR =5.122,P =0.000) were risk factors of perioperative complications.The follow-up time was (5.7±4.6) years.Totally 27 patients were lost from follow-up,103 patients died for the disease during follow-up.The survival rate at 1-,3-,5-,10-,15-and 20-years was 93.6％,86.9％,80.1％,59.3％,54.1％ and 38.5％ respectively.Univariate analysis showed that gender (male),age (≥ 48 years),hemorrhage before surgery (≥500 ml per time),hepatitis virus and without portosystemic collateral vessels reserved were risk factors of the long-term survival (P ＜ 0.05).Cox regression analysis showed that age (≥48 years) (X2 =9.850,RR =1.904,P =0.002),hemorrhage before surgery (≥ 500 ml per time)(X2 =34.402,RR =3.273,P =0.000),hepatitis virus (X2 =7.573,RR =2.525,P =0.006) and without portosystemic collateral vessels reserved (x2 =5.905,RR =１.889,P =0.015) were independent risk factors that affect the long-term survival.Conclusion Devascularization with portosystemic collateral vessels reserved has favorable perioperative and long-term outcome,and it definitely is a very safe and effective technique for portal hypertension.

Objective To study the the effect of national free pre-pregnancy health check policy from the view of clinical labora-tory.Methods Couples who accepted pre-pregnancy check were recruited in the study.720 people were recruited.The data of pre-pregnancy health examination and related questionnaire were analyzed.Results In females,the IgG positive rates of rubella virus, cytomegalovirus and Toxoplasma were 80.34%,3.78% and 87.51%,respectively.IgM positive rates of Toxoplasma and cytomeg-alovirus were 0.73% and 1.24% respectively.17.98% females were found suffering from gynecological inflammation or ovarian cysts and other gynecological diseases.Syphilis test showed males positive rate was 0.83%,female positive rate was 0.59%.Ala-nine aminotransferase(ALT)test showed that male positive rate was 13.22%,female was 5.71%.For cognitive health examination surveys,92.33% males and 96.27% females had well known the importance of pre-pregnancy health examination.Conclusion Free pre-pregnancy health examination policy could provide a guarantee for the couple's family planning,and could reduce the incidence of malformation and neonatal congenital disease.