Objective To evaluate the ultrasonographic ( US ) findings of granulomatous lobular mastitis( GLM ) ,and to compare the diagnostic accuracy among US ,mammographic ,and magnetic resonance imaging ( MRI) . Methods Imaging characteristics of 56 patients who were pathologically comfirmed as GLM were reviewed .All the lesions were assessed by BI‐RADS ( Breast Imaging Reporting and Data System) . Results Fifty‐eight lesions were found in 56 patients . Thirty ( 51 .7% ) were irregular ,20 (34 .5% ) were lobular and 8(13 .8% ) were round or oval in shape . Forty two lesions (72 .4% ) were hypoechoic ,14 (24 .1% ) were mixed echoic textur ,including 6 lesions (10 .3% ) with tubular connections and 8 lesions ( 13 .8% ) with irregular markly hypoechoic internal echoes . Two ( 3% ) were isoechoic .No calcification were found . Color Doppler signals were detected in 33 cases(56 .9% ) ,and the resistance index ( RI) ranged from 0 .61 to 0 .79 . Forty patients underwent mammography ,there were no distinct lesions in 6 cases(15% ) ,suspicious calcification in two(5% ) , asymmetric density in twenty(50% ) ,and solitary masses in twelve(30% ) . MRI was performed in 36 patients ,and revealed no abnormality in two patients(5 .6% ) , twenty nine lesions ( 80 .6% ) showed hypointensity on T1‐weighted images and hyperimensity on T2‐weighted images ,five lesions ( 13 .9% ) showed isointensity on T1‐weighted images and hyperimensity on T2‐weighted images ,and all the lesions showed heterogeneous enhancement after contrast .The diagnostic accuracy of ultrasonography , mammography and MRl was 63 .8% , 45% and 61 .1% , respectively . Conclusions There were no specific imaging characteristics of GLM ,the combination of ultrasonography , mammography and MRI might benefit the diagnosis of GLM .

Objective To investigate the value of shear wave elastography (SWE)for differential diagnosis of benign and malignant thyroid nodules.Methods A total of 1 56 patients referred for surgery of thyroid nodules underwent standard ultrasound as well as elastography.The following characteristics of all the nodules were assessed:location,size,shape,margin,echogenicity,calcification and blood flow.The SWE elasticity indices of maximum (Emax),mean (Emean),minimum (Emin),and standard deviation (Esd) were automatically calculated by the US system.Thresholds were calculated by receiver operating characteristic (ROC ) curve analysis.The diagnostic performance of conventional US and SWE were compared.Histopathologic examination was used as the reference standard.Results Among a total of 1 56 nodules,1 1 8 were malignant and 38 were benign.SWE elasticity indices were significantly higher in malignant than in benign nodules (P ≤0.001 ).Sensitivity and specificity for predicting malignancy were 83.9%,92.1 % respectively using Emean with a threshold of 32.1 kPa,the specificity was significantly higher than using conventional ultrasound (P <0.05 ).Area under the ROC curve (Az)of Emean was highest (0.880,95% CI:0.81 7,0.943),however the differences were not significant(P >0.05).Conclusions SWE provides higher specificity for predicting malignancy without losing sensitivity.

Objective To analyze the ultrasonographic characteristics of breast cystic-solid lesions and to investigate the diagnostic value of BI-RADS breast imaging reporting and data system in this kind of disease Methods Imaging characteristics of 105 breast cystic-solid lesions of 93 patients were analyzed All the lesions were assessed by BI-RADS Histopathologic examination was used as the reference standard Results Among 105 lesions 57 54 3% were benign and 48 45 7% were malignant Differences in orientation shape margin calcification and vascularity were statistically significant between the benign and malignant lesions P < 0 05 whereas the echo pattern and the posterior acoustic feature did not show significant differences P >0 05).There were 5 1 predominantly solid mass,which appeared as solid mass with little dispersed or centralized cystic regions or solid mass with surrounding cystic regions,including 33 benign lesions and 1 8 malignant lesions.The area under the curves of ROC was 0.956 in this type.There were 25 lesions predominantly cystic,which had regular or irregular thick walls or septa,or had nodules protruding to the cystic component,including 1 1 benign lesions and 14 malignant lesions.The area under the curves of ROC was 0.753.There were 29 mixed solid-cystic mass,in which the solid component equaled to the cystic,including 13 benign lesions and 16 malignant lesions.The area under the curves of ROC was 0.887.The area under curves of ROC was 0.873 for the all breast cystic-solid lesions.The rates of malignant cystic-solid lesions in the three types had no significant difference(P >0.05).Conclusions Ultrasound is a useful tool for diagnosing breast cystic-solid lesions.The proportion of the cystic component is not helpful to differentiate malignancy from benignancy.

Objective To study the tolerance to 188Re-1-hydroxy-1 ,1-ethylidene disodium phosphonate(HEDP) in patients with bone pain caused by osseous metastases. Methods Thirty-one patients(10with prostate cancer, 9 with breast cancer, 3 with lung cancer, 5 with liver cancer, 2 with rectal cancer, 1with esophageal cancer and 1 with renal cancer) received a single injection dose of 188Re-HEDP. The patients were divided into four groups according to the injection dose: 20 MBq/kg (6 patients), 30 MBq/kg(6 patients), 40 MBq/kg (9 patients), and 50 MBq/kg (10 patients). Haematological toxicity (WHO grading) of grade Ⅲ- Ⅳ was considered unacceptable. Vital signs and adverse effects after injection were recorded for 8 weeks. Blood counts were measured weekly during a period of 8 weeks. Biochemical parameters and electrocardiogram were assayed at week 4 and 8. Statistical analysis was performed for per-protocol (pp) population (t-test). Results Twenty-seven patients belonged to PP population with 5 in the group of 20 MBq/kg, 5 in the group of 30 MBq/kg, 8 in the group of 40 MBq/kg and 9 in the group of 50 MBq/kg.No obvious adverse effects and no significant change of vital signs, electrocardiogram, liver and renal function were found after injection. Alkaline phosphatase was slightly higher than baseline at week 4 and 8 after therapy, but the difference was not statistically significant. In the 20 MBq/kg group, reversible grade Ⅰ leucopenia was noted in 1 patient. In the 30 MBq/kg group, 2 patients showed reversible grade Ⅰ leucopenia including 1 alone with reversible grade Ⅲ thrombopenia. In the 40 MBq/kg group, reversible grade Ⅰ leucopenia and thrombopenia was observed in 1 patient and reversible grade Ⅱ leucopenia and thrombopenia in another patient. In the .50 MBq/kg group, 3 patients showed reversible grade Ⅱ leucopenia. The lowest level of thrombopenia was at week 4(143.5 × 109/L), leucopenia at week 6 (5.4 × 109/L) and anaemia at week 8(t = 3.1325, 3.3156, 3.4917, all P ＜ 0. 05 compared with baseline). At week 8, the mean level of platelet and leucocyte recovered to baseline. "Bounce pain" was found in 2 of 27 patients (7.41%).Conclusions The dose of 20 MBq/kg, 30 MBq/kg, 40 MBq/kg or 50 MBq/kg of 188Re-HEDP do not cause significant side effects on cancer patients with bone metastases, though there is a tendency that the haematological toxicity may increase as the dose of 188Re-HEDP increases.

Objective: To study the glycoside chemical constituents of Bletilla striata grown in Guizhou Province. Methods: The glycoside chemical constituents were separated and purified by silica gel column chromatography, MCI, gel column chromatography, medium pressure preparation, highperformance liquid chromatography and other modern separation methods. The structures were identified based on the spectral data. Results: Thirteen glycosides were isolated from the 95% ethanol extracts: 1-methyl-3-phenylpropyl-β-D-glucopyranoside (1), 1-(4-β-D-glucopyranosyl oxybenzyl) 4-ethyl (2R)-2-isobutylmalate (2), 3’,5- dimethoxy-bibenzyl-3-O-β-D-glucopyranoside (3), syringaresinol mono-β-D-glucoside (4), 4-O-(6’-O-glucosyl-p-coumaroyl)-4- hydroxybenzyl alcohol (5), (4-hydroxyphenyl) methyl-β-D-glucopyranoside (6), 4-methylphenyl-β-D-glucopyranoside (7), benzyl-β-D- glucopyranoside (8), phenyl-β-D-glucopyranoside (9), 4-[(acetyloxy) methyl] phenyl-β-D-glucopyranoside (10), batatasin III-3-O- glucoside (11), gastrodin (12) and 4-(4-β-D-glucopyranosyl-oxybenzyl)-(2R)-2-isobutylmalate (13). Conclusion: Compound 1 is a new natural product. Compounds 3-6 are isolated from this plant for the first time; Compounds 2, 7-13 are obtained from this genus for the first time.

Objective To retrospectively study the quantitative features and diagnostic value of 3-dimensional shear wave elastography (3D-SWE) in breast lesions.Methods A total of 198 consecutive women with 198 breast lesions (125 malignant,73 benign) were included,who underwent conventional ultrasound (US) and 3D-SWE before surgical excision.Quantitative parameters of transverse planes,sagittal planes and coronal planes were calculated,including maximum elasticity (Emax-w),mean elasticity (Emean-w),standard deviation (Esd) of the whole lesion and ratio between the stiffest elasticity (Emean-s)in the lesion and the fatty tissue (Eratio).Area under ROC curve(AUC) for combination of quantitative parameters and US were calculated.Results The AUC,sensitivity and specificity for US were 0.919,88.0％ and 78.1 ％,respectively.In the total 198 lesions,Emax-w,Emean-w,Esd,Eratio and Emean s were significantly lower in coronal planes than those in transverse and sagittal planes (all P ＜0.001).AUC for combination of each quantitative parameter and US were significantly higher than those of US (all P ＜0.05),except Emean-w of transverse plane,while there was no significant difference among the three orthogonal plane (P＞0.05).Sensitivity significantly increased by combining US with Emean-s,Eratio (transverse,sagittal and coronal planes),Emean-w (coronal and sagittal planes) or Esd (coronal and transverse planes) (all P＜0.05).Combination of US and Emean w of coronal plane yielded significantly higher sensitivity than those of transverse and sagittal planes.Conclusions Combination of quantitative features of 3D-SWE and US can significantly increase diagnostic accuracy and sensitivity in breast lesions.Emean-w of coronal plane yields the highest sensitivity.

Objective To retrospectively study the anisotropy of shear wave elastography (SWE)quantitative parameters of breast lesions,and the correlation with histopathology.Methods A total of 281 consecutive women with 281 breast lesions (179 malignant,102 benign) were included,who underwent conventional ultrasound (US) and 2D SWE before surgical excision.Three acquisitions each for transverse and longitudinal planes were obtained,and maximum elasticity (Emax),mean elasticity (Emean),standard deviation (Esd) of the whole lesion and ratio between the elasticity in the mass and the fatty tissue (Eratio)were recorded.Anisotropic difference (AD) and anisotropy factors (AF) were calculated,and correlation with histopathology was analyzed.Results The average Emax,Emean and Esd of transverse planes were significantly higher than those of longitudinal planes.AF showed positive correlation with quantitative elasticity (Emax,Emean,Esd and Eratio) (P =0.000),and was significantly higher in malignant lesions than that in benign besions (P =0.000).AUC of AF was significantly higher than that of AD (P ＜0.001).AF was significantly higher in invasive ductal carcinoma than that in ductal carcinoma in situ.Higher AF was associated with higher histopathological grades of invasive ductal carcinoma (P =0.000),and correlated with ER/PR(+).Conclusions Anisotropy of SWE is an indicator of malignancy of breast lesions,and is of predictive value for prognosis in breast cancer.

Objective To analyze the clinical speciality of invasive fungal infection(IFI)and provide doctors with clinical evidence for early anti-fungal therapy.Method One hundred and thirty-seven patients with 91 male and 46 female,who suffered from invasive fungal infection in ICU from January.1,2000 to June 30, 2006,were enrolled in this study.The age ranged from 17 to 82 years old.Out of 137 patients with IFI,the percentage of albicans candida,glabirate candida,tropicalis candida and parapsilosis candida were 47.4%, 26.3%,20.4% and 3.6%,reseparately.The sputum,urine,blood and other drainages were collected to perform the fungal examination after three days of admission every three days.Results Of 137 patients,42 of them were complicated with hemorrhage,53 patients with IFI developed candida anthema in the chest,abdomen and extremity.,49 patients suffering from IFI had organ dysfunction.The chest image revealed that infiltration caused by IFI especially occurred in apex of lung in some patients.The pathogen analysis displayed that albicans candidiasis easily developed candida anthema,glabirate candidiasis frequently resulted in organ dysfunction,and tropicalis candida led to hemorrhage in some organs.Conclusions The clinical specialty,of IFI caused by candida included hemorrhage,candida anthema,organ dysfunction,and infiltration in apex of lung.

Objective To investigate the influence of breast pure mucinous carcinoma size on sonographic characteristics and diagnostic accuracy.Methods Sonographic characteristics of 101 breast pure mucinous carcinoma in 1 00 patients were analyzed retrospectively.All lesions were divided into three groups according to maximum diameter at ultrasound.These were group Ⅰ with lesions less than 20 mm,group Ⅱwith lesions greater than or equal 20 mm,less than 40 mm,and group Ⅲ with lesions greater than or equal 40 mm.The relationship between lesions size and ultrasound parameters were analyzed.Results There were 38 lesions in group Ⅰ,52 lesions in group Ⅱ and 1 1 lesions in group Ⅲ.The patients age in group Ⅲwere older than that in group Ⅰ(F=3.442,P =0.036).Among these sonographic appearances,only shape (χ2=9.813,P =0.005)and blood flow (χ2=27.952,P =0.000)indicated significant differences.The accuracy of ultrasound diagnosis of breast cancer was 85.1%,the smaller the lesions were,the higher misdiagnosis rate the lesions were.Conclusions With lesions size increased,the lobular and internal blood flow of pure mucinous carcinoma increased.More smaller the lesions were,more higher misdiagnosis rate of lesions were.

Objective To investigate the value of ultrasound-guided diffuse optical tomography (US-guided DOT) to predict clinical efficacy of breast cancer neoadjuvant chemotherapy (NAC).Methods Eighty-eight breast cancer patients with 93 lesions were included.Pre-and post-last chemotherapy,the size,total hemoglobin concentration (THC) of each lesion were measured by ultrasonography (US) and US-guided DOT.Based on the guidelines to evaluate the response to treatment in solid tumors,the lesions of treated breast cancer patients were divided into 4 types of responses to NAC:complete response (CR),partial response (PR),stable disease (SD),and progressive disease (PD).Efficient groups include CR and PR groups.Results As expected,no significant difference was found in size and THC for untreated lesions (all P ＞0.05).However,for the treated lesions(P =0.001),THC,pre-vs post-treatment size changes (△Size％) (P =0.002) and THC changes (△THC％) (P ＜0.001) were significantly varied among CR,PR,SD,PD groups.When compared with pre-treated,tumor sizes after treatment were changed significantly in all CR(P ＜0.001),PR(P ＜0.001),SD (P =0.023) and PD (P =0.001),while significant change of THC was only found in CR(P ＜0.001),PR(P ＜0.001) and SD (P =0.002).When △THC％ =23.9％ as the threshold for prediction of NAC efficiency,the area under the curve of ROC was 0.75,and the sensitivity was 73.7％,specificity was 76.5 ％,positive predictive value was 93.3 ％,negative predictive value was 39.4％,accuracy was 74.2％.Conclusions △size％ changes in consistent with △THC％ among the intergroups,but their changes levels are different,the highest change percent appears in CR,gradually decreased in PR,SD groups.△THC％ will contribute to predict preoperative clinical NAC efficacy.