Objective To investigate the clinicopathologic characteristics and prognosis of triple negative breast cancer patients. Methods A retrospective analysis was performed for 1042 primary breast cancer patients admitted in the First Affiliated Hospital of Nanjing Medical University from January 2003 to December 2009.All breast cancer patients were categorized into three subgroups by immunohistochemistry:ERBB2 +,HR +/ERBB2 - and triple negative. Results Of 1042 breast cancer patients recruited,183 patients were in triple negative group.The rate of larger tumors ( greater than 2 cm in diameter) and grade Ⅲ in triple negative patients was higher than that in ERBB2 + and HR +/ERBB2 - patients (P ＜0.01 ).The positive rate of p53 status in ERBB2 + patients was higher than that in triple negative and HR +/ERBB2- patients (P ＜ 0.01 ).No significant differences were observed in other clinical variables.In survival analysis,more bone metastases were observed in HR +/ERBB2 - patients than in ERBB2 + and triple negative patients (P =0.006).However,no significant difference was observed in visceral metastases among the subgroups.There were significantly different recurrence-free survivals (RFS) among the three subgroups throughout the follow-up period ( P =0.029),the 5-year RFS of ERBB2 + was 80.3％,which was the worst in three groups. Conclusions Triple negative patients had higher rate of larger tumors (greater than 2 cm in diameter) and grade Ⅲ than that in ERBB2 + and HR +/ERBB2 - patients,while its 5-year RFS was higher than ERBB2 + patients.

ObjectiveTo study the scope of excison in breast-conserving surgery for breast carcinoma.MethodsClinical data of 275 breast cancer patients undergoing breast-conserving surgery in t he First Affiliated Hospital of Nanjing Medical University,the Affiliated Zhenjiang Hospital of Jiangsu University and Changzhou Traditional ChineseMedicine Hospital were retrospectively analyzed.The operation procedure and postoperative adjuvant therapy were carried out with the same protocol.Local and general conditions of patients were followed up regularly.Results271 out of 275 patients got follow-up.The follow-up rate was 98.5％.The follow-up time ranged from 1 month to 117 months,median follow-up time was 34 months.Six patients died of distant metastasis,2 with local recurrence.The 1-year,3-year,and 5-year overall survival rates were 99.5％,98.1％,and 95.7％,respectively.ConclusionsIt is safe to excise 1 cm normal breast tissue with clear margin confirmed by frozen section,followed by postoperative adjuvant therapy,endocrine therapy,and radiotherapy,this improves the life quality of patients with breast cancer.It is safe and effective to determine whether the disease is multicentric or multifocal by mammogram plus clinical breast examination.

Objective:To investigate the accuracy of a threshold-based segmentation method based on cone beam breast CT(CBBCT) images in breast density measurement,and its value for breast-type classification and breast cancer screening.Methods:A retrospec-tive analysis of 195 patients who had undergone CBBCT examination at Tianjin Medical University Cancer Institute and Hospital be-tween May 2012 and August 2014 was performed.A total of 64 breasts were analyzed.On the basis of the classification criteria for breast density in BI-RADS,they were classified into four types and the majority report was reported.Breast density was measured by the threshold-based segmentation method based on CBBCT images and corrected manually to obtain the corrected breast density.A month later,the procedure was repeated.Intra-class correlation coefficients(ICCs)were used to compare the intra-observer and inter-observer consistencies of threshold-based segmentation and manually corrected breast density measurement results for non-dense and dense breasts.Results:For threshold-based segmentation measurements the intra-observer and inter-observer ICC values were 0.0.9624(95% CI:0.9388~0.9770)and 0.9666(95% CI:0.9500~0.9785).For manually corrected measurements,the intra-observer and inter-observer ICC values were 0.9750 (95% CI: 0.9592~0.9847) and 0.9775 (95% CI: 0.9661~0.9855). The ICC between the threshold-based segmentation method and manual correction was 0.9962 (95% CI: 0.9983~0.9977). The ICC values of threshold-based and manually corrected measurement in non-dense and dense breasts were 0.9497(95% CI:0.7072-0.9914)and 0.9983(95% CI:0.9971-0.9990),respectively.Conclusions:The threshold-based segmentation method based on CBBCT is a reliable and accurate com-puter-aided method of measuring breast density.It is expected to be applied in large-scale screening of breast cancer and to provide more information for predicting the risk of breast cancer.

Objective To evaluate the accuracy of cone?beam breast CT (CBBCT) on tumor sizing in patients with invasive breast carcinoma and analyze the influence factors. Methods The preoperative CBBCT images of 82 female patients (85 breast lesions) with invasive breast carcinoma confirmed by pathology from November, 2011 to December, 2017 in Tianjin Medical University Cancer Hospital were included in this retrospective study. All the patients underwent the pathology and immunohistochemical test after operation. Tumor size estimation were performed on preoperative CBBCT images. Referring to tumor size measurement on pathology, all the lesions were divided into two groups. Concordance was defined as the discrepancy in diameter less than 0.5 cm, and the discordance was more than 0.5 cm. Pathology examination was performed after resection, and estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2(HER?2) and Ki?67 result were recorded. All the lesions were classified into molecular subtype, including 14 Luminal A, 50 Luminal B, 11 HER?2?enriched and 10 triple?negative. Intraclass correlation coefficient (ICC) and Pearson correlation coefficient were used to analyze the reliability of CBBCT on tumor sizing. CBBCT?pathology discordance was analyzed based on the clinical, histopathology and CBBCT features by using t test, Chi?square and Fisher exact test. ROC curve was used to analyze the cut?off value between tumor size and CBBCT?pathology discordance. Results The agreement between CBBCT (2.155 ± 0.799) cm and pathology (1.986 ± 0.933) cm measurement was on moderate degree based on the ICC value (ICC=0.781, P<0.01) and had positive correlation (r=0.803, P<0.01). CBBCT?pathology concordance was found in 71 lesions, and discordance in 14 lesions. The factors of family history, symptom, pathology type, molecular subtypes, histological grade, surrounding fat invasion, lymphatic invasion, axillary lymph node metastasis, HER?2 positive and Ki?67 high expression had no significant difference between two groups. ER or PR positive had significant difference, suggesting that the accuracy of evaluation on ER or PR negative lesions could be reduced. The cut?off value of ROC curve between tumor size and CBBCT?pathology discordance was 2.08 cm, and the area under curve was 0.70. In 85 lesions. 66 of 75 mass lesions and 5 of 10 non?mass lesions were consistent. The lesion type had significant difference between two groups (χ2=6.705, P=0.010), which suggested the CBBCT evaluation on non?mass could have discrepancy with pathology. Conclusion CBBCT has high accuracy on tumor size evaluation on invasive carcinoma. ER or PR negative, large lesions or non?tumor lesions should be alert to the impact of CBBCT?pathology discordance before surgery which may cause the alteration of surgical protocols.

Objective:To summarize the etiology, laboratory examinations and clinical features of rhabdomyolysis(RM)in children.Methods:The clinical data of children with RM admitted to the pediatric general ward at Third Hospital of Peking University from January 1st, 2010 to March 31st, 2021 were collected.The clinical characteristics, etiology distribution, laboratory examinations, treatments and prognosis of the children were analyzed.Results:A total of 24 children were included with 16 males and 8 females.The age ranged from 4 to 15 years old, with median age was 13years old.The etiology was exertional diseases in 14 cases(58.3%), non-exertional diseases in ten cases (41.7%, 7 cases of infection and 3 cases of other causes). The average age of exertional RM was(13.50±1.83)years, and that of non-exertional RM was(8.60±3.72)years.There was significant difference( t=3.848, P=0.002). The main clinical symptoms were muscle soreness, abnormal urine color and muscle weakness.Serum creatine kinase(CK)and serum myoglobin were significantly increased.The proportion of CK value moderate to severe increased of exercise RM children was significantly higher than that of non-exertional RM children( P=0.009). All children were treated with hydration and alkalization.Except for one case who died of critical primary disease, the other 23 children had good treatment response, and no rhabdomyolysis was found during the follow-up. Conclusion:The main causes of rhabdomyolysis in children are exercise and infection.Exertional RM is common in elder children.The increasing of CK level caused by exertional RM is more obvious.Active hydration and alkalization measures could avoid the occurrence of acute kidney injury.Most children with RM have good prognosis.

UNLABELLEDOBJECITVE: To established an efficient method for simultaneous quantification of 7 compounds belonging to 4 chemical types in Psoralea corylifolia processed by different methods, and to elucidate variations of 4 kinds of compounds in different processed P. corylifolia.

METHODThe chromatographic separation was performed on an ACUITY C18 column using acetonitrile and 0.1% formic acid aqueous solution in the gradient elution at 0.4 mL x min(-1). Detection wavelength was set at 246 nm. Column temperature was fixed at 50 degrees C.

RESULTThe 4 kinds of compounds including psoralenoside, isopsoralenoside (benzofuran glycosides), psoralen, isopsoralen, psoralidin (coumarins), bavachin (flavonoids), and bakuchiol (meroterpenes) were separated in 25 min. The correlation coefficients of those compounds were over 0.9993 in the tested range. The intra- and inter-day precisions were below 1.5%. The average recoveries ranged from 99.2% to 106%.

CONCLUSIONThis method is simple, rapid and accurate, which can be used for the determination of the 4 kinds of compounds in different processed P. corylifolia. In P. corylifolia processed by different methods, the contents of benzofuran glycosides, flavonoids, and meroterpenes in P. corylifolia processed by Leigong's method decrease obviously, while the contents of psoralen and isopsoralen increase significantly.

Objective: To explore the mediating, direct and indirect roles of self-efficacy, social support and medical coping modes with resilience in patients with chronic hepatitis B. Methods: Totally 384 inpatients and outpatients with chronic hepatitis B, without physical ailments or mental problems were selected.The Connor-Davidson resilience scale (CD-RISC), general self-efficacy scale (GSES), medical coping modes questionnaire (MCMQ) and social support rating scale (SSRS) were adopted in this research.The relationship among all variables was explored by path analysis. Results: (1)The total scores of resilience, self-efficacy, social support, confrontation, avoidance and acceptance-resignation in chronic hepatitis B patients were (61.64±15.36), (25.40±5.70), (39.82±7.39), (19.02±3.72), (16.63±2.69) and (8.45±2.94), respectively.(2)Pearson analysis showed that the scores of self-efficacy, medical coping and social support were significantly correlated with resilience(r=-0.26-0.82, P<0.05). (3)Importantly, path analysis showed that self-efficacy(β=0.53), confrontation(β=0.10), avoidance(β=0.17) and acceptance-resignation(β=-0.13) had direct prediction effects on resilience.Additionally, self-efficacy was indirectly related to resilience(β=0.05), and social support also indirectly related to resilience through self-efficacy, confrontation and acceptance-resignation(β=0.18). Conclusion Self-efficacy, social support and medical coping are the important factors which play a direct or indirect role in resilience.

Objective:To investigate the value of logistic regression model based on the features of cone-beam breast CT (CBBCT) for the identification of benign and malignant masses in dense breast.Methods:The data of 106 patients (130 masses) with dense breast who underwent contrast-enhanced CBBCT examination and obtained pathological results from May 2011 to August 2020 were retrospectively analyzed as the training set. From August 2020, the data of 49 patients (54 masses) who met the same criteria were prospectively and consecutively collected and used as the validation set. Taking pathological results as the gold standard, the training set was divided into benign and malignant groups. The t-test, χ 2 test and Fisher′s exact test were used to compare the differences in CBBCT image characteristics between the two groups in the training set. A binary logistic regression model was established by multivariate analysis. ROC curves were used to assess the diagnostic efficacy of the model as a whole in the training and validation sets and the diagnostic efficacy of each feature in the model, and the cut-off value of the intensity (ΔCT) value was determined. The H-L method was used to test the goodness of fit of the model. Decision curve analysis (DCA) was drawn to validate the clinical power of the model. Results:Univariate analysis showed that the breast parenchymal background enhancement (BPE), shape, margin, lobulation, spiculation, density, calcifications, ΔCT value, enhancement pattern, non-mass enhancement, ipsilateral increased vascularity (IIV), and peripheral vascular signs had statistical difference between benign group and malignant group ( P<0.05). BPE, margin, ΔCT value and IIV were included in the multivariate analysis, the equation was logit( P′)=-8.510+0.830×BPE+0.822×margin+1.919× ΔCT+1.896 × IIV. The are a under curve of the model in the training set was 0.879 ( P<0.001) and in the validation set was 0.851 ( P=0.001). The are a under curve of BPE, margin, ΔCT value, and IIV in the diagnosis of malignant mass were 0.645, 0.711, 0.712, 0.775 (all P<0.05); the best cut-off value of ΔCT was 50.38 HU. The fit of this model was good ( P = 0.776). The DCA curve showed that when the risk threshold was 0.05-0.97, the net benefit rate was>0, and this model had some clinical value. Conclusion:The logistic regression model based on the features of CBBCT is helpful to distinguish benign and malignant masses in dense breasts.

Anemia, Aplastic ; drug therapy ; immunology ; Animals ; Antilymphocyte Serum ; immunology ; therapeutic use ; Calcineurin Inhibitors ; immunology ; therapeutic use ; Humans ; Immunoglobulins ; immunology ; therapeutic use ; Lymphocytes ; drug effects ; immunology ; Swine