Objective To assess the feasibility of semi-quantitative scoring system for contrast-enhanced ultrasound (CEUS)quantitative analysis's color images in the differential diagnosis of breast nodules.Methods Totally 244 BI-RADS 4 breast solid lesions received CEUS before core needle biopsy or surgical resection were included.A semi-quantitative scoring system for color images of CEUS quantitative analysis were built.The scores were given as follows:1 )Color type and its distribution (0 to 4);2)Color scope (0 to 1 );3)Color margin (0 to 1 );4)Color shape (0 to1 ).The total score for each lesion would be from 0 to 7.And the differenital value between benign and malignant lesions were assessed.Results The total semi-quantitative scores of 102 malignant tumors (5.1 ±1 .7)was significant higher than that of benign lesions (3.34±0.7)(P < 0.05 ).In 102 malignant lesions,the total scores of 81 lesions (79.41 %)were more than 4 points,and in 142 benign lesions,the total scores of 89 lesions (62.67%)were less than 4 points.Depending on the Wilcox rank sum test (Mann-Whitney)analysis,the distribution of total scores between benign and malignant lesions was significant different (P <0.000 1).Total score 4 was selected as the best cutoff,the area under ROC curve was 0.749,on which the sensitivity,specificity and accuracy were 79.4%,62.7% and 69.67%,respectively.Conclusions The semi-quantitative scoring system of CEUS quantitative analysis color images showed good sensitivity but not satisfied specificity and accuracy in differential diagnosis between malignant and benign breast lesions.

Objective To observe the therapeutic efficacy and action mechanism of muscle-region alignment electroacupuncture in treating post-stroke shoulder pain. Method Eighty patients were randomized into a muscle-region alignment needling group and a conventional acupuncture group. The Short-form McGill Pain Questionnaire (SF-MPQ), and serum levels of IL-6, TNF-?, and NO were majorly observed before and after the treatment. Result The muscle-region alignment electroacupuncture and conventional acupuncture both obviously reduced the SF-MPQ score and down-regulated the serum levels of IL-6, TNF-?, and NO, and the decreases by the muscle-region alignment electroacupuncture were more significant than that by the conventional acupuncture. Conclusion The action of muscle-region alignment electroacupuncture in treating post-stroke shoulder pain is plausibly by down-regulating serum levels of IL-6, TNF-?, and NO, reducing or inhibiting the production of inflammatory factors and restraining inflammation.

Objective To analyze the genotype and plasmid transfer of Enterobacteriaceae carring blaNDM‐1 with blaIMP‐4 or blaKPC‐2 .Methods From April 2012 to October 2014 ,a total of 33 non‐repeatitive carbapenem‐resistant Enterobacteriaceae ( including Imipenem‐resistant , meropenem‐resistant or Ertapenem‐resistant) were isolated from 5 hospitals in Wenzhou and Hangzhou . Identification and antimicrobial susceptibility test were performed using Vitek 2 Compact automatic microbiology analyzer . Phenotypes of carbapenemase were screened using modified Hodge test and ethylenediamine tetraacetic acid‐disk synergy test .Extended spectrum βlactamase test was determined by the double disk combination test which was recommended by Clinical and Laboratory Standards Institute .AmpC activity was tested by a three‐dimensional Cefoxitin method .Drug resistant genes including blaNDM‐1 and linkage of ISAba125‐NDM were detected by polymerase chain reaction (PCR) .The purified PCR products were cloned and sequenced .Plasmid conjugation experiment and elimination method were carried out to test partial bacterial strain and K . pneumoniae carrying blaNDM‐1 with blaIMP‐4 or blaKPC‐2 .Results Of the 33 non‐repeatitive carbapenem‐resistant Enterobacteriaceae ,28 were strains of K .pneumoniae ,1 strain of K . oxytoca,2strainsof Escherichiacoli,1strainof K.planticolaand1strainof E.cloacae.Thirteenstrains were isolated from Hospital of Sir Run Run Shaw of Zhejiang University ,thirteen from Wenzhou Hospital of Traditional Chinese Medicine ,one from Wenzhou People′s Hospital ,three from the First Affiliated Hospital of Wenzhou Medical University and three from Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine .Thirty‐one strains were confirmed as carbapenemase‐producing with 24 of blaKPC‐2 ,3 of blaNDM‐1 ,1 of blaNDM‐5 and 3 of blaIMP‐4 .Among them ,one strain carried blaNDM‐1 with blaIMP‐4 and one strain carried blaNDM‐1with blaKPC‐2 ,respectively .The plasmid transfer and conjugation experiment was performed between strains carrying blaNDM‐1 and Escherichia coli EC600 or K . pneumoniae ATCC13833 and genes of blaNDM‐1 and ISAba125‐NDM were obtained .Conclusions blaKPC‐2 gene is the popular carbapenemase genotype .blaNDM‐1 or blaNDM‐5 may be correlated with linkage gene of ISAba125‐N DM .Coexistence of blaNDM‐1 carrying blaIMP‐4 or blaKPC‐2 is detected in the same strain , respectively . Enough importance should be attached to the strains ,because most of them are multiple drug resistance with related genes located in the plasmid which is easily spread between strains .

Objective To investigate the relationship between parotid image texture and acute radiation xerostomia (grade) during radiotherapy in patients with head and neck cancer.The mathematical model was established to predict the severity of radiation dry mouth in the early stage.Methods 23 patients with head and neck cancer treated with radiotherapy were observed.The degree of xerostomia was evaluated according to RTOG criteria.The weekly validated CT images of these patients during radiotherapy were collected and transmitted to the MIM system to outline the parotid gland,and an internal analysis program was developed in MATLAB (R2013a).The changes of texture features of weekly parotid CT images during radiotherapy were analyzed,including mean CT value (MCTN),standard deviation (STD),skewness,kurtosis,entropy and volume.The mathematical model was established,and the KNN method was used to optimize the model and predict the level of xerostomia.Results There was no significant correlation among the changes of MCTN,volume and the degree of xerostomia (P ＞ 0.05).However,according to the weekly changes of MCTN and volume,the model was established to predict the grade of xerostomia with an accuracy of 99％.Conclusions The changes of parotid gland MCTN and volume were significantly correlated with acute radiation xerostomia during radiotherapy for head and neck cancer,and the MCTN changes can be used to predict the severity of xerostomia in the early stage.

Objective:To explore the distribution of different subsets of monocyte in peripheral blood of patients with thyroid-associated ophthalmopathy (TAO).Methods:A cross-sectional study was performed.Fifty-nine TAO patients and 30 healthy subjects were recruited continuously in Zhongshan Ophthalmic Center from January 2017 to December 2019.Clinical data of subjects were recorded, and the severity and activity of TAO were graded based on the criteria of NOSPECS and CAS.TAO patients were grouped according to clinical activity of TAO, and the patients were treated by triamcinolone acetonide (TA) injection or methylprednisolone pulse therapy (MPT) accordingly.Peripheral blood of the subjects was collected and monocytes were isolated.The proportion of different monocyte subsets was assayed by a flow cytometry.The differences in distribution of monocyte subsets between TAO group and normal control group, stable TAO group and active TAO group, TA injected group and MPT treated group were compared and analyzed.The study protocol was approved by the Ethics Committee of Zhongshan Ophthalmic Center, Sun Yat-Sen University (No.2014MEKY005), and the written informed consent was obtained from each subject before any medical intervention.Results:The proportion of classical monocyte (CMo) subset in TAO group was (81.77%±5.53)%, which was significantly lower than (84.35±5.83)% in the normal control group ( P=0.034); the proportion of intermediate monocyte (IMo) subset in the TAO group was (10.17±4.19)%, which was significantly higher than (7.69±4.09)% in the normal control group ( P=0.006); no significant difference was found in the proportion of non-classical monocyte (NMo) subset between the two groups ( P=0.892). The proportion of CMo subset in the active TAO group was (77.29±5.80)%, which was significantly lower than (82.64±5.03)% in the stable TAO group ( P<0.01), and the proportion of IMo subset in the active TAO group was (13.79±4.82)%, which was significantly higher than (9.20±3.56)% in the stable TAO group ( P<0.01); no significant change was found in the proportion of NMo subset between the two groups ( P=0.283). There was no difference in the proportion of different TAO subsets before and after TA injection ( P>0.05). In MPT treated group, the proportion of CMo subset in TAO patients was significantly increased and the proportion of IMo subset was significantly decreased (both at P<0.05); there was no significant difference in proportion of NMo subset before and after MPT treatment ( P=0.187). Conclusions:IMo subset is enriched in patients with TAO, and the IMo subset content varies over the disease activity.MPT may inhibit the shift of CMo subset towards IMo subset.

ObjectiveTo investigate the deafness genetic mutation spectrum in nonsyndromic hearing impairment (NSHI) associated with enlarged vestibular aqueducts (EVA). MethodsFrom October, 2015 to August, 2016, 85 patients with NSHI from Hubei Yichang Special Education School were examined with temporal bone CT, and 20 deafness-related gene mutations in GJB2, GJB3, SLC26A4 and mtDNA 12S rRNA were detected with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. ResultsA total of 31 patients were found EVA with temporal bone CT. Compared with non-EVA patients, the proportion of deafness-related gene mutations was more in patients with EVA (χ² = 11.160, P = 0.001), especially for c.919-2A>G mutation of SLC26A4 (χ² = 23.870, P < 0.001). ConclusionThe deafness gene mutation spectrum is different in NSHI patients with or without EVA. It is needed to optimize genetic testing scheme for deafness for early diagnosis and intervention of NSHI associated with EVA.