Objective To evaluate the b value of diffusion-weighted(DW)MRI in distinguishing between benign and malignant breast lesions.Methods Three diffusion-weighted sequences were implemented with 500,1000 and 2000 s/mm~2 b values respectively on 95 breast lesions in 83 patients.All lesions were confirmed by pathology.The apparent diffusion coefficient(ADC)values and signal intensity (SI)were recorded and compared in different lesions(breast cancer,benign lesion,cyst and normal beast tissue)with the same b value and the same lesions with the different b values.Results(1)The mean ADC value and SI of breast cancer were 1.375?0.378 and 839.713?360.493 respectively with b= 500 s/mm~2,1.176?0.311 and 459.314?229.609 with b=1000 s/mm~2,0.824?0.198 and 243.825? 110.616 with b=2000 s/mm~2.The differences in the mean ADC value were significant between two type lesions(cancer and benign lesion,cancer and cyst,cancer and normal breast tissue)with b values of 500 s/mm~2 and 1000 s/mm~2.But the significant differenee was only seen between cancer and benign lesions when b value was 2000 s/mm~2.(2)The one-side upper limits of 95% confidence interval of mean ADCs were adopted as the point to separate the malignant from the benign lesions,the sensitivity was 70.92%, 70.73% and 69.77%,the specificity was 77.19%,75.70% and 54.76%,the accuracy was 77.12%, 74.32% and 62.35% respectively with b values of 500 s/mm~2,1000 s/mm~2 and 2000 s/mm~2.The areas under ROC eurves were Az_(500)=0.775?0.046(P0.05).Conclusion DWI MRI is useful for the differential diagnosis of breast lesions with b values of 500 s/mm~2 and 1000 s/mm~2.

Objective To study the effect of bromocriptine(BRC) on the activation of T lymphocyte stimulated by phytohemagglutinin(PHA).Methods After CD4+ T cell line Jurkat E6-1 cells were stimulated by PHA,prolactin(PRL) and BRC,respectively,the expression of linker for activation of T cells(LAT) and zeta-chain T cell receptor associated protein kinase 70 000(ZAP-70) mRNA of T lymphocytes were checked by RT-PCR.The expression of PRL mRNA of T lymphocytes was detected by Real time PCR.The expression of CD25(cluster of differentiation) as a marker of early activation on the surface of T lymphocytes was detected by flow cytometry,and the activation of nuclear factor-?B(NF-?B) was detected by luciferase reporter system.Results 1.BRC inhibited the expression of ZAP-70 as the common signal molecules both in the T lymphocyte activation pathway and PRL-prolactin-prolactin receptor(PRLR) signal transduction pathway,and decreased the expression of PRL mRNA produced by activation T lymphocytes.2.BRC enhanced the expression of LAT mRNA as another important signal molecular on the T lymphocytes and CD25 on the surface of the T lymphocytes.3.The activation of NF-?B of T lymphocytes was decreased.Conclusions BRC might inhibit the activation of T lymphocytes by inhibiting the expression of ZAP-70,the common signal molecules between T lymphocytes activation and PRL-PRL pathway,and PRL mRNA,the like-T lymphocyte growth factor.

Adolescent ; Adult ; Altitude ; External Fixators ; Female ; Follow-Up Studies ; Fracture Fixation ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Tibial Fractures ; pathology ; physiopathology ; surgery ; therapy ; Treatment Outcome ; Young Adult

When the glomerular mesangial cells of rats were cultured in vitro at high glucose concentration,the activity of extraeellular signal-regulated kinase(ERK),the expression of transforming growth factor-?_1(TGF-?_1)mRNA and the content of typeⅣcollagen in the supematant were higher than those at normal glucose concentration.These effects were inhibited by fluvastatin.The results showed that the activation of ERK signal transduction pathways appeared to play a role in the onset and progression of diabetic nephropathy. Furthermore,fluvastatin could protect the kidney by inhibiting ERK signal transduction pathway and TGF-?_1 expression.

OBJECTIVETo investigate the optimal operation method for the management of various chronic wounds in legs and feet.

METHODSFifty-one chronic wounds were evaluated according to infection, inflammatory response, and distribution in different areas of the leg and foot. Preoperative treatment was given accordingly, then transposition of skin flap, skin grafting, or amputation was performed. The healing rate after single session operation and average hospitalization were statistically analyzed.

RESULTSThe wound healing rate after single session operation was 86. 3% , the average hospital stay was (17. 8 +/- 2. 1) days, and the appearance and function of the leg and foot after operation was satisfactory.

CONCLUSIONThe appropriate preoperative treatment and operation method conforming to the wound location and evaluation are of vital importance in the management of chronic wounds in the leg and foot. Operation is one of the most effective ways to repair chronic wounds in the leg and foot, and it can shorten the wound healing process and restore the function.

Adult ; Chronic Disease ; Foot Ulcer ; pathology ; surgery ; Humans ; Leg Ulcer ; pathology ; surgery ; Longevity ; Male ; Surgical Flaps ; Wound Healing

OBJECTIVETo summarize the methods and results of the surgical treatment of patients with multiple pressure sores.

METHODSTwenty-one patients with 56 multiple pressure sores, hospitalized from January 2001 to May 2007, were treated with transfer of various skin flaps together with skin grafting. The pressure sores were respectively located in sacrococcygeal region (21 wounds), ischial tuberosity (14 wounds), greater trochanter of femur (13 wounds) and other sites (8 wounds). All the patients were given systemic supporting treatment in perioperative period and early debridement . The wounds were repaired with flaps, fascio-musculocutaneous flaps, or free skin grafts according to their size, depth, position and the condition of adjacent skin and soft tissue. Continuous irrigation, negative pressure suction, regular posture changes in turning frame after operation were also emphasized.

RESULTSTwenty-five wounds were repaired by fascio-cutaneous flap or myocutaneous flap with healing rate of 90%. Thirteen wounds were repaired by adjacent regional flap with healing rate of 85%. Eight wounds were treated with direct suturing,among which 6 healed completely. Ten wounds were treated with free skin grafting,among whom 7 healed completely. Among 9 delayed healing wounds, 4 wounds healed after debridement and suturing or free skin transplantation for second time, 4 wounds healed by dressing change in a short time, and in the last a chronic sinus remained. Follow-up over 6 months, multiple pressure sores recurred in 3 patients.

CONCLUSIONEnhancing systemic supporting treatment in perioperative period, using fascio-cutaneous flap or myocutaneous flap to repair multiple sores, followed by continuous irrigation and negative pressure suction after operation, and regular postural change on turning frame, contribute a rate of success for management of multiple pressure sores.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pressure Ulcer ; surgery ; Reconstructive Surgical Procedures ; Skin Transplantation ; Surgical Flaps ; Wound Healing ; Young Adult

Adult ; Aged ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Tibia ; injuries ; surgery ; Tibial Fractures ; surgery ; Young Adult

Objective To retrospectively assess diagnostic accuracy of magnetic resonance imaging (MRI)in preoperative assessment of local extent of breast ductal carcinoma in situ(DCIS)and DCIS with small invasive foci,compared with the mammography and ultrasonography(US)imagings.Methods Results of MRI,mammography,and US imaging from 17 consecutive women with known breast DCIS and DCIS with invasive foci were analyzed,and then compared with pathologic examination.Results(1) Fourteen lesions showed enhancement on dynamic breast MRI,of which 11 lesions were no-mass-like enhancement.Six of 11 lesions appeared segmental enhancement,and 2 were regional enhancement.Ductal and multiple focal areas enhancement were 1 case respectively.Symmetric diffuse enhancement in bilateral breast was showed in 1 patient.Ductal dilation was visible in ipsilateral breast on pre-contrast MRI in 2 cases,which manifested bloody nipple discharge in clinical examination,and duct enhanced on post- contrast imaging in one of them.Two lesions appeared mass enhancement with irregular shape and homogeneous signal.Linear enhancement surrounding the oval homogeneous mass with smooth margin found in 1 case.(2)Thirteen of 17 patients underwent bilateral mammography.There were various findings in mammograms,including microcalcifications(6 cases),normal mammograms(2 cases),calcifications with other appearance(2 cases),and non-calcification abnormity(3 cases).In 8 lesions with calcifications, 5 were noted higher probability of malignancy calcifications and 3 intermediate concern calcifications. Calcifications distributed clustered(5 cases),regional(2 cases)and diffuse(1 case)shape.(3)Sixteen of 17 patients were performed breast US examination.Eleven lesions,which were correct diagnosed, appeared higher echo spots within irregular lower echo area.One lesion diagnosed benign and 4 were negative on US examination.(4)Regarded the size measured on pathologic examination as golden standard, accordance of lesion extent was 13 of 17 case in MRI,7 of 13 in mammography,and 7 of 16 in US.There were 2 lesions overestimation of extent in MRI,3 in mammography,and 2 in US.Underestimation of extent showed 1 case and 3 cases in mammography and US imaging respectively.The difference was not significant (P = 0.161).Conclusion The MR imaging features of DCIS and DCIS with small invasive loci were characteristic.The combination of MRI and mammography could improve diagnostic accuracy.

Objective To evaluate the development of the sphincter muscle complex(SMC)and defecation function in pediatric patients with congenital anorectal malformations(ARM).Methods A total of 64 children underwent MRI,among whom 39 were patients with ARM,and the others were patients without ARM undergoing MRI because of other dieases.The dimensions of the SMC in different planes were evaluated with different sequences and coils.The relationship between the SMC development and the defecation function was investigated.Results In control group,the absolute value of SMC width was (3.63?0.22)mm,which had a high correlation with age(r=0.998,P0.05).The SMCs in intermediate ARM patients[muscle index(MI)=0.47?0.05]and low ARM patients(MI=0.49? 0.05)were well developed.The SMCs in a portion of patients with high ARM(MI=0.28?0.06)were poorly developed,when MI≤0.18,anorectal contraction pressurewas significantly lower(t=3.55, P0.18[(0.85?0.20)vs(2.24?1.02)kPa].The length of anal canal with high-pressure[(10.88?3.64)vs(20.26?4.34)mm]was shorter(t=5.18,P0.18,the anorectal angle was less than 90 degrees,and normal continent function was found in 21 of 23 cases(91%).Conclusion MRI can be employed to evaluate the development of SMC in patients with ARM,MI was an objective criteria to evaluate the development of SMC.When MI≤0.18, maldevelopment of SMC will be highly suspected.

Objective To investigate the feasibility of determining the breast cancer extension with diffusion-weighted imaging(DWI)and the apparent diffusion coefficient(ADC).Methods Fifty-nine lesions(57 patients)were studied by using DWI and ADC measurement before surgical excision.The cancer extension was investigated on ADC maps with different b values(b=500 and 1000 s?mm~(-2))according to the threshold values discussed before.The lesion extension on dynamic enhanced images and on DWI was used for comparison.The tumor extension was determined by calculating two lines.Line one:the maximum diameter of lesion.Line two:perpendicular line crossing the midpoint of line one.All measurement was compared with the pathologic specimen.Results(1)There were 48 invasive ductal carcinomas,6 ductal carcinomas in situ with small invasive foci,3 mucinous carcinomas,and 2 medullary carcinomas.(2)The low ADC value on ADC maps at b=500 and 1000 s?mm~(-2)was described as cancer extension.The measurement results were compared to pathologic figures and the pattern of correlation was categorized into 3 groups:Group 1,the area of low ADC values was almost the same as the pathological tumor extension; Group 2(overdiagnosis),the area of low ADC values was wider and more than 20% larger than the area of tumor extension;Group 3(false negative),no area of low ADC value was observed.There were no significant difference between DWI with b of 500 and b of 1000 s?mm~(-2)(X~2=0.160,P=0.689;X~2= 0.172,P=0.679)in Groups 1 and Group 3.There were 2 lesions in Group 2,which were consistent in DWI with b of 500 and b of 1000 s?mm~(-2).There were 14 misdiagnosed lesions,including overdiagnosis in 2 lesions and false negative in 12 lesions.Eight lesions measured at DWI with b of 500 and b of 1000 s? mm~(-2)were not consistent.Five lesions were diagnosed correctly at DWI with b of 500 s?mm~(-2),three of them were duetal carcinomas in situ with small invasive foci.(3)The extension of lesion on dynamic enhanced imaging was measured at 4 minutes after enhancement,and was compared with the extension measured at the same slice on DWI map.Pathologic figures were regarded as the gold standard.The extension of 47 lesions(80%)on enhanced images accorded with DWI.The abnormal area on DWI,which was consistent with pathologic figures,was wider than the area on enhanced images in 8 lesions.Of them,3 lesions were mucinous carcinomas and 5 lesions were grade 3 invasive ductal carcinomas.Conclusion DWI and ADC value have the potential in evaluating the cancer extension.The accuracy of extension measured on DWI map was better than that on dynamic enhanced images for some kinds of breast cancers.