Objective To investigate the clinical significance of c-myc、Bcl-2 protein expression, DNA ploidy and their relationship in breast cancer. MethodsWT5”BZ The expression of c-myc、Bcl-2 protein in 146 breast tumor tissues was examined by using immunohistochemical methods(S-P)and DNA ploidy in 72 cases of breast carcinoma by flow cytometry. ResultsKG1 Nuclear expression of c-myc protein was detected in 9 6% of tumors, and it was related to the DNA aneuploidy and prognosis. Cytoplasmic expression of c-myc protein was present in 91 8% of the carcinomas. Moderate to strong c-myc protein expression in cytoplasmic was associated with the positive status of ER. Bcl-2 protein was positive in 78 8% of cancers. Overexpression of Bcl-2 protein was associated with ER(+) status and the lack of axillary lymph node metastasis. DNA aneuploidy was found in 51 4% of 72 cancers, it was related to nuclear expression of c-myc protein and prognosis.WT5”HZConclusion Nuclear expression of c-myc protein and DNA ploidy are important prognostic factors.

Objective To study the expressions of hypoxia inducible factor-1 α (HIF-1 α) and carbonic anhydrase 9 (CA9) in different molecular subtypes of breast carcinoma and their relationships with basallike subtype.Methods The expressions of HIF-1α and CA9 were detected by immunohistochemistry in five subtypes of breast carcinoma (n =803).The relationships of the expressions of HIF-1α and CA9 with the clinicopathologic parameters of basal-like subtype and with the prognosis of patients were analyzed.Results The positive expression rates of HIF-1α and CA9 protein in breast carcinoma were much higher than those in paratumor breast tissues (43.96％ vs.3.86％,x2 =354.858,P ＜ 0.001;19.80％ vs.4.61％,x2 =86.495,P ＜ 0.001).The positive expression rates of HIF-1α in Luminal A,Luminal B,epidermal growth factor receptor-2 (HER-2) over-expression,basal-like and normal breast-like subtypes were 31.97％,25.00％,56.06％,77.89％ and 55.76％ respectively,and the positive expression rates of CA9 were 7.48％,5.56％,60.61％,40.00％ and 27.88％ respectively,with significant differences (x2 =88.628,P ＜ 0.001;x2 =147.128,P ＜0.001).The positive expression rates of HIF-1α and CA9 in estrogen receptor (ER)-negative breast carcinomas(HER-2 over-expression,basal-like and normal breast-like) were significantly higher than those in ER-positive subtypes (Luminal A and Luminal B,all P ＜ 0.005).There was a significant positive correlation between HIF-1 α and CA9 (C =0.315,P =0.001),and both were correlated with the lymph node metastasis (x2 =4.542,P =0.033;x2 =7.025,P =0.008),pTNM stage (x2 =5.390,P =0.020;x2 =10.179,P =0.001) and poor prognosis (x2 =4.353,P =0.037;x2 =6.056,P =0.014) of basal-like subtype.Conclusion Over-expressions of HIF-1α and CA9 may be related to the ER-negative breast cancer more closely,and both may play important roles in the occurrence and development of basal-like subtype.Overexpressions of HIF-1α and CA9 may suggest the poorer prognosis of patients with basal-like breast carcinoma.

Objective:To investigate the safety of early hip fracture surgery for elderly patients on clopidogrel.Methods:This retrospective study included 242 consecutive elderly patients (≥65 years) with acute hip fracture who had undergone surgery at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital between November 2016 and April 2017. Of them, 20 were assigned into the study group who had taken clopidogrel before injury but discontinued its use within 4 days before surgery. They were 6 males and 14 females, with a median age of 80 years (77, 81). Their operation procedures for hip fracture included internal fixation with cannulated screws for femoral neck fracture in 2 cases, hemiarthroplasty for displaced femoral neck fracture in 11 cases, and internal fixation for intertrochanteric fracture in 7 cases. The control group included 222 patients who had undergone the same operative procedures but not taken any antiplatelet or anticoagulant drugs. The 2 groups were compared in terms of time between admission and operation, operation duration, intraoperative blood loss, perioperative transfusion and complications related to bleeding to analyze the safety of early surgery.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). There was no significant difference between the 2 groups in the time between admission and operation [42.5 (36.3, 48.0) h for the study group versus 43.0 (28.0, 61.0) h for the control group] ( P=0.870). The median time between the last use of clopidogrel and operation was 55.0 (30.5, 71.0) h. There were no significant differences between the 2 groups in preoperative hemoglobin, operation duration, intraoperative blood loss, rate or amount of perioperative blood transfusion, or rate or amount of wound drainage ( P>0.05). The rate of general anesthesia was significantly higher for the study group (45.0%, 9/20) than for the control group (18.5%,41/222) ( P=0.012). No complications related to spinal hematoma occurred in the patients receiving spinal anesthesia from the study group. Wound hematoma and subsequent infection occurred in 2 patients from the control group. Conclusion:Early hip fracture surgery is safe for elderly patients on clopidogrel.

Objective To investigate the systolic synchrony of the left ventricle in patients with left ventricular hypertrophy (LVH) or with heart failure but preserved ejection fraction (HF-PEF),and to evaluate the impact of systolic dyssynchrony on left ventricular function.Methods During June 2011 to May 2014,a total of 352 patients(160 males,192 females,average age:(67.6±7.8)years) with essential hypertension (EH) were enrolled in this retrospective study.Ultrasonic and G-MP1 were performed for assessment of left ventricular remodeling and systolic synchrony and the results were statistically analyzed by oneway analysis of variance and x2 test.Relationship between BNP and synchronic parameters as well as other clinical factors were analyzed by partial correlation analysis.Results The EH patients were divided into hypertension group (rt =182),LVH group (n =74) and HF-PEF group (n =96).In comparison to hypertension group,significant LVH developed in LVH and HF-PEF groups although the LVEF was still preserved.The LVMI of the 3 groups were (94.4±10.1),(121.1±9.8) and (123.2±10.9) g/m2,respectively(F=8.66,P＜0.05).The LVEF was (58.6±7.3)％,(60.8±10.4)％ and (55.1±4.6)％,respectively(F=2.89,P＞0.05).Diastolic dysfunction was identified in LVH and HF-PEF groups with significantly reduced E/A ratio (1.19±0.23,0.80±0.28,0.67±0.17;F=13.46,P＜0.05).Remarkable left ventricular systolic dyssynchrony with phase histogram bandwidth (PHB) of (88.4±8.6) ° and phase standard deviation (PSD) of (23.6±1.9)° and increased BNP of (228.4±69.7) ng/L were revealed in HF-PEF group.The BNP in HF-PEF group was significantly higher than that in LVH group((92.5±13.6) ng/L;q=8.63,P＜0.05).Positive correlation was found between BNP level and PHB,PSD,LVMI,respectively (r=0.277-0.331,all P＜0.05).Conclusion Left ventricular systolic dyssynchrony is concomitant with HF-PEF patients induced by EH,and this dyssynchrony might be one of the factors leading to diastolic dysfunction.

Objective To investigate the effect of exercise on the recovery of locomotor and neurological function in rats after incomplete spinal cord injury (SCI). Methods Ninety-five male Sprague Dawley rats were randomly divided into a control group, a training group (including subgroups which received training for 1 week, 2 weeks, 3 weeks and 4 weeks) and a sham operation group. The control and training groups were administered an SCI model at the T_(10) level by extradural compression using a modified Allen's stall with a damage energy of 40 g-cm. These rats were loosely restrained and given partial weight-bearing treadmill training 5min/time, twice a day for 1-4 weeks. Locomotor and neurological function were evaluated with inclined plane tests, modified Tarlov scores, the Basso-Beattie-Bresnahan scale and spinal cord somatosensory evoked potential (SCSEP) before injury and at different time points thereafter. Results Locomotor function improved significantly at different time points during the train-ing, and significantly better than in the control group. In the rats trained for 2-4 weeks, SCSEP latency shortened sig-nificantly compared to the control group. The latency shortened gradually with longer exercise. Conclusions Exer-cise with partial weight support may improve locomotor and neurological function. The improvements are correlated closely with the duration of the training.

Defibrillators, Implantable ; Electric Countershock ; Humans ; Ventricular Fibrillation

Objective:To investigate the characteristic of ultrasound in diagnosing fetal intestinal volvulus.Methods:From April 2015 to May 2018, four cases of fetal intestinal volvulus indicated by prenatal ultrasound in the Affiliated Hospital of Jining Medical College and confirmed either by autopsy or by postnatal surgery, were retrospectively analyzed. A total of 11 ultrasound scans had been performed on the four cases, and the dynamic and static ultrasound features were summarized. Pregnancy outcomes and concomitant malformations were also followed up. Descriptive statistical analysis was used.Results:The direct ultrasonographic patterns of intestinal volvulus in the four cases were "whirlpool" signs (six times), clockwise wrapping of branch vessels of the superior mesenteric vein and the superior mesenteric artery (five times), and "coffee bean" sign (three times); the indirect signs included dilated small intestine (11 times), ascites (eight times), polyhydramnios (five times), peritoneal calcification(four times), pseudocysts(once). Out of the 11 ultrasound examinations, early-stage volvulus was detected on three occasions, all with "whirlpool" signs and clockwise wrapping of branch vessels of the superior mesenteric vein and the superior mesenteric artery. As the disease progressed to the meconium peritonitis stage, indirect signs emerged while the initial two signs can diminished. Postnatal surgery or autopsy after labor induction confirmed the segmental volvulus in the four cases, of which three were complicated by intestinal atresia. No intestinal malrotation was found.Conclusion:Typical direct signs and atypical indirect signs could be identified in the sonogram findings of fetal volvulus, and are important for diagnosing fetal volvulus.

Objective:To investigate the diagnostic value of transthoracic echocardiographic contrast-enhanced ultrasound (cTTE) in patent foramen ovale (PFO) and the value of combined neutrophil to lymphocyte ratio (NLR) in predicting cryptogenic stroke.Methods:A total of 120 suspected PFO patients admitted to the Affiliated Hospital of Jining Medical College from January 2021 to December 2021 were selected and examined by cTTE and transesophageal echocardiography (TEE) to analyze the diagnostic value of cTTE in PFO. The clinical data and cTTE parameters of PFO patients with and without cryptogenic stroke were analyzed.Results:A total of 69 patients with PFO were confirmed. Among the 69 patients, 23 patients with cryptogenic stroke and 46 patients without cryptogenic stroke were confirmed by magnetic resonance imaging (MRI). The value of cTTE in the diagnosis of PFO was high: the sensitivity, accuracy and negative predictive value of cTTE under Valsalva motion in the diagnosis of PFO were 95.65%, 91.67% and 93.62%, respectively, which were significantly higher than that of cTTE at rest (all P<0.05). The NLR, the proportion of large shunt of PFO right to left shunt (PFO-RLS), the inlet width of patent foramen ovale (PFO) and the outlet width of PFO in patients with PFO complicated with cryptogenic stroke were (3.01±0.89), 43.48%(10/23), (2.54±0.65)mm and (1.51±0.35)mm, respectively, which were significantly higher than those in patients without cryptogenic stroke (all P<0.05). Logistic regression analysis showed that NLR and the degree of PFO-RLS shunt were the influencing factors of patients with PFO complicated with cryptogenic stroke (both P<0.05). The area under the Receiver operating characteristic (ROC) curve predicted by NLR combined with PFO-RLS shunt was 0.905, which was significantly higher than that predicted by NLR and PFO-RLS shunt alone (all P<0.05). Conclusions:cTTE has a good value in the diagnosis of PFO, and cTTE combined with NLR has a certain application value in predicting PFO complicated with cryptogenic stroke.

Objective:To investigate the clinical effects of antibiotic-loaded calcium sulfate-autologous iliac bone combined with sural neurocutaneous flap in the one-stage treatment of chronic calcaneus osteomyelitis plus skin and soft tissue defects.Methods:From January 2013 to September 2019, 48 patients were admitted to Department of Orthopedic Trauma, Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University for chronic calcaneal osteomyelitis complicated with skin and soft tissue defects. They were divided into 2 groups according to different bone grafts. In group A of 26 patients treated at one stage by antibiotic-loaded calcium sulfate-autologous iliac bone combined with sural neurocutaneous flap, there were 16 males and 10 females with an age of (45.0±11.7) years and an area of skin defect of (56.0±16.7) cm 2. In group B of 22 patients treated at one stage by simple autologous iliac bone combined with sural neurocutaneous flap, there were 13 males and 9 females with an age of (43.6±9.6) years and an area of skin defect of (53.8±16.2) cm 2. The volume of the ilium harvested, fracture healing time, infection control, donor site complications, pain score of visual analogue scale (VAS) and function recovery of the ankle were compared between the 2 groups. Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The 48 patients were followed up for (15.3±6.0) months. Group A had a significantly smaller volume of the ilium harvested [(67.3±14.1) cm 3] than group B [(90.7±23.5) cm 3], a significantly lower rate of donor site complications [3.8% (1/26)] than group B [31.8% (7/22)], significantly lower VAS pain scores at 6, 12, 24, 48 and 72 hours than group B, and significantly lower WBC count, erythrocyte sedimentation rate and C-reactive protein at 2, 4, 8 weeks after operation than group B (all P<0.05). There was no statistically significant difference between the 2 groups in the infection control rate [96.2% (25/26) versus 77.3% (17/22)], the fracture healing time [(6.2±1.9) months versus (6.4±2.1) months], or the ankle-hindfoot score of AOFAS (The American Orthopaedic Foot and Ankle Society) (83.9±7.2 versus 82.5±8.7) at 6 months after operation (all P>0.05). Conclusion:In one-stage treatment of chronic calcaneal osteomyelitis complicated with skin and soft tissue defects, compared with simple autologous iliac bone combined with sural neurocutaneous flap, antibiotic-loaded calcium sulfate-autologous iliac bone combined with sural neurocutaneous flap can reduce the volume of the ilium harvested, pain score of VAS, and incidence of donor site complications, and improve the recovery of inflammatory indicators, leading to fine clinical effects.

This paper reported the ultrasonographic findings and pregnancy outcome in a case of fetal cervical aortic arch complicated by premature closure of ductus arteriosus. Ultrasound at 22+6weeks of gestation showed that the apex of fetal aortic arch reached the level of left clavicle, but no obvious abnormality in fetal intracardiac structure was found. Ultrasound examinations showed premature contraction of the fetal ductus arteriosus at 25+ 4 weeks of gestation and premature closure at 27+6 weeks. The pregnant woman was hospitalized due to the aggravation of fetal right heart failure at 34+1 gestational weeks and delivered by cesarean section at 34+3weeks. After 17 d of intensive care, the newborn was discharged in good condition. Ultrasound examination performed three months after birth showed that the aortic arch was at the level of left clavicle and the right cardiac system recovered well.