Objective To evaluate the reliability of benign nodules diagnosed by ultrasound and analyze the probable factors of infecting the BI-RADS ultrasound categorization of breast lesions. Methods A total of 792 cases with initial category 3 assessments on BI-RADS ultrasound categorization consistent with more than 2 years follow-up or pathologic results were contained. The reliability of probable benign lesions were studied retrospectively,and several factors that could influence the categorization were explored such as age,breast lumps size,multiplicity,palpability,and US radiologist's experience referring to ACR-BI-RADS and the new categorizations recommendation. Results Of 792 breast nodules, 781 (98.6%) were benign and 11 (1.4%) were malignant. If the new categorizations recommendation was applied, 35. 1% (278/792) of all cased would have been upgraded to BI-RADS 4,81. 8% (9/11)of malignant tumors would have been found. The breast masses diagnosed by the junior radiologists were more frequently upgraded to BI-RADS 4 than senior radiologists' findings (P <0. 05), the nodules in women 40 years or older and multiple lesions were more frequently upgraded to category 4 (P <0. 01). The presence of palpability and mass size had on significantly influence the BI-RADS US categorization of breast nodules. Conclusions BI-RADS-Ultrasound categorization is relatively reliable to diagnose breast benign nodules. The multiplicity of breast nodules,patient's age and US radiologist's experience were found to have significant influences on the categorizations of probably benign breast nodules.

Objective: To evaluate the effect and safety of molecular targeted therapy of apatinib mesylate combined with multiple antigen stimulatiing cellular therapy in treatment of osteosarcoma and soft tissue sarcoma. Methods:Six patients with sarcoma were collected by the failure of surgery, radiation and chemotherapy treatment or refusal surgery, radiation and chemotherapy, and at least one month from the last treatment of surgery, radiation and chemotherapy. All of the patients at least received three cycle MASCTTM . From Day 1,everyone were given Apatinib 500 mg,po,qd ,until the disease progression. To measure the patient’s quality of life depending on EORTC QLQ-C30,meanwhile,detecting the cellular immunity function and circulating tumor cells(CTCs) of patients before treatment and one month after 3 cycle MASCTTM . At last, monitoring the cellular immune responses by the Enzyme-linked immuno spot ( ELISPOT) assay. Results: All of the four patients completed the treatment of 3 cycle MASCTTM . Only one patient reduced apatinib from 500 mg to 250 mg because of palmar-plantar erythrodyses-thesia. The response rates of the four patients received MASCTTM and apatinib mesylate after treatment were 1 for complete response (CR),3 for partial response (PR). The life quality and cellular immunity function were improved in all of the patients. ELISPOT assay suggested that the majority of antigen peptides could induce specific cytotoxic T lymphocytes( CTLs) response. The Progression-Free-Survival ( PFS) of four patients received MASCTTM and apatinib mesylate was 7,6,9 and 4 months ,while the response rates of the two patients received apatinib mesylate were 1 for ( Stable disease) SD,one for ( Progression disease) PD. And PFS of the two patients were one month and two months. Conclusion:Combination of MASCTTM and apatinib mesylate is safe,effective and were good prospects for application.

AIM: To clone and express a human monoclonal anti-D Fab fragment in E. coli and make benefits for the expression of the whole immunoglobulin molecules of anti-D. METHODS: The gene of anti-D Fab fragment was cloned into the phagemid vector pComb3. After analyzing by PCR and restriction site analysis, the recombinant was expressed in E. coli and the expressed protein was analyzed by SDS-PAGE and ELISA. RESULTS: The result of SDS-PAGE confirmed that E.coli expressed a 48 kD protein. The ELISA result demonstrated that the cell culture supernatant reacted with Rh+ group O human erythrocytes, but was not recognized by Rh-group O human erythrocytes. CONCLUSION: Expressed Fab fragment has the antigenic specificity for human erythrocytes.

Objective To evaluate the efficacy and safety of the hyper-CVAD/MA regimen as an intensified treatment option for 28 T cell and aggressive/highly aggressive B cell NHL in Chinese patients. Methods Clinical data of 28 NHL patients treated with hyper-CVAD/MA regimen from Jan 2005 to Sep 2008 were retrospectively analyzed. Results 27 NHL patients were available for the efficacy analysis, with a response rate of 70.4 %. For the 13 B cell lymphoma cases, the response rate was 84.6 %. The main toxicity was Grade Ⅲ or Grade Ⅳ myelosuppression in all cases and 2 treatment related deaths. Conclusion Hyper-CVAD/MA regimen had a high response rate in T cell and aggressive /highly aggressive B cell NHL lymphoma, companied by significant toxicity when treating Chinese patients. Further clinical practices are needed to pick up a suitable dose which can balance efficacy and safety.

Because there is no serosal layer in the esophagus, cT4b stage esophageal cancer is prone to invade trachea, lung, aorta and other important organs with tumor metastasis, and the overall prognosis is very poor. The clinical results of radical chemotherapy or radiotherapy for these patients with advanced unresectable esophageal cancer are not ideal. In recent years, with the proposal of conversion surgery, patients with advanced unresectable esophageal cancer, surgical resection should be performed after the tumor-lowering stage and achieved through induction therapy. Some studies have reported its effectiveness and feasibility. However, there are different studies and reports on induction therapy regimens and postoperative survival rates. This paper reviews the development, induction therapy methods, surgical efficacy and prognosis of conversion surgery, aiming to summarize the clinical application of conversion surgery in recent years. To provide a theoretical basis for further formulation of the treatment strategy of this mode.

OBJECTIVETo report the operative techniques and clinical results of modified distally based superficial peroneal neurocutaneous flap for skin defect of the forefoot.

METHODSA reversed superficial peroneal neurocutaneous flap pedicled with the lateral superamalleolar perforating artery or its descending branch, which vascularized the flap through the nutrient vessel chain of the nerve, which linked vascular territories of superamalleolar perforating artery, cutaneous branches of the anterior tibial artery and superficial peroneal artery, was designed to repair skin defects in the forefoot.

RESULTSThe modified flaps were applied in 17 cases. All flaps were survived successfully with no complication. The largest size of the flap was 20 cm x 8 cm. The flap could reach as far as the proximal end of the second and third toes or weight-bearing areas under the fifth metatarsal caput.

CONCLUSIONSThe modified flap has reliable blood supply with a relatively large size and long rotation arc. It is a simple and safe for covering medium to large defects in the forefoot.

Adolescent ; Adult ; Child ; Female ; Foot Injuries ; surgery ; Humans ; Male ; Middle Aged ; Peroneal Nerve ; surgery ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; innervation ; Young Adult

Due to the influence of immunosuppression, nerve injury and other comprehensive factors, the overall incidence of gastrointestinal complications after lung transplantation is relatively high, which can cause drug absorption disorder and chronic rejection. In recent years, more and more studies have been conducted on these complications. However, due to the great difference of the incidence of gastrointestinal complications among lung transplantation centers, clinicians lack of understanding of these. In this article, the general status, common types and risk factors of gastrointestinal complications after lung transplantation were reviewed, aiming to provide reference for comprehensive management of gastrointestinal complications after lung transplantation.

Objective:To investigate the value of detection of cell-free fetal DNA in maternal peripheral blood for Down's syndrome screening.Methods:A total of 1667 pregnant women who were at a higher risk of having a baby with Down's syndrome who received Down's syndrome screening in the First People's Hospital of Datong between January 2020 and March 2021 were prospectively analyzed. After detection of cell-free fetal DNA in maternal peripheral blood, pregnant women who were at a higher risk of having a baby with Down's syndrome decided whether to accept amniocentesis for fetal karyotype. Then follow-up was performed for collecting related information. Finally, detection results of cell-free fetal DNA in maternal peripheral blood, fetal karyotype results and pregnancy outcomes were analyzed.Results:The positive predictive value of detecting cell-free fetal DNA in maternal peripheral blood for trisomy 21, trisomy 18, and trisomy 13 and chromosome abnormality were 100.0%, 100.0%, 0.0% and 66.7%, respectively. The sensitivity and total specificity of detecting cell-free fetal DNA in maternal peripheral blood were 100.0% and 99.8%, respectively. The false positive rate of detecting cell-free fetal DNA in maternal peripheral blood for trisomy 13 and chromosome abnormality was 0.12% and 0.06%, respectively.Conclusion:A high degree of coincidence between detection results of cell-free fetal DNA in maternal peripheral blood and fetal karyotype results can be used as a prenatal screening for Down's syndrome. This has certain guiding significance for invasive prenatal diagnosis through amniocentesis-based fetal karyotype analysis.

OBJECTIVETo study the distribution of the dominant perforators (the diameter > or = 0.8 mm) of the peroneal artery with color Doppler flow imaging (CDFI) for the purpose of anatomical preparations for the perforator sural neurocutaneous flap.

METHODSThe dominant perforators of the peroneal artery (DPPA) were studied with CDFI on bilateral legs of 20 healthy volunteers. The numbers, diameters and locations of the perforators were recorded for a statistical analysis. From Jan. 2005 to Jan. 2009, 51 free or pedicled sural neurocutaneous flaps supplied by a single DPPA were designed and harvested to repair the defects near the ankle (n=22), at the leg (n=15) and the forefoot or hand dorsum (n=14). The perforators were located preoperatively with CDFI and accuracy of CDFI was evaluated intraoperatively. The causes of false results were analysed to improve examining techniques.

RESULTSThe average number of DPPA was 4.2 with the average diameter of (1.13 +/- 0.24) mm (0.80-1.90 mm). They were located in the second to ninth segment of the line from the fibular caput to the tip of lateral malleolus which was equally divided into nine segments. The largest DPPA was (1.43 +/- 0.29) mm (1.00-1.90 mm) in diameter and most of them were located in the third to fifth segment (80.4%). The average diameter of the lowest DPPA was (1.02 +/- 0.16) mm( 0.80-1.30 mm) and they were located between the sixth to ninth segment. The total 169 DPPA as well as the largest ones mostly appeared in the middle third of the leg. All of the 51 flaps were transplanted successfully without necrosis, and no vascular problems occurred. Preoperative CDFI examination had a 93.6% true-positive rate and an 88.0% positive predictive value. What should be demonstrated was that if just considered the cases after Dec. 2007, the true-positive rate was 97%, and the positive predictive value was 93.9%.

CONCLUSIONSAccording to the distribution characteristics of DPPA, a sural neurocutaneous flap pedicled with one of this relatively large perforator can be designed and harvested to repair skin defects of leg and around ankle, but can not be utilized for that of forefoot. With anastomosis of the perforator, the flap based on the largest DPPA can be used as a free flap to cover defect anywhere. CDFI is reliable in preoperative location of DPPA, which makes the surgical procedures easier.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Leg ; blood supply ; Male ; Middle Aged ; Sural Nerve ; Surgical Flaps ; blood supply ; Tibial Arteries ; anatomy & histology ; diagnostic imaging ; Ultrasonography ; Young Adult

Objective To study the prevalence,treatment policy and control of hypertension in patients with maintenance hemodialysis, and to analyze the influencing factors of hypertension control.Methods We studied the current status of 1382 patients with maintenance hemodialysis in 11 dialysis centers in Shanghai, among them 809 were male, and 573 were female.Hypertension was defined as systolic blood pressure(SBP) ≥ 140 and/or diastolic blood pressure (DBP) ≥90 mm Hg ( 1 mm Hg = 0.133 kPa).Those who had a history of hypertension and requiring antihypertensive therapy were also diagnosed as hypertension though their blood pressure was within normal range during the survey.Hypertension control was defined as blood pressure ＜ 140/90 mm Hg before each dialysis session.Results The prevalence of hypertension in the hemodialysis patients was 86.3%.The treatment rate and control rate in those patients were 96.8% and 25.5% respectively.More than half (50.4% ) of patients were treated with only one kind of anti-hypertensive drug, and 34.4% with 2 kinds, 14.2% with 3 kinds, 1.0% with 4 kinds or more.Calcium channel blocker (CCB) was the most frequently prescribed drug (61.0%), followed by angiotensin Ⅱ receptor blockers ( 56.4% ), centrally acting anti-hypertensive agent ( 26.4% ), beta blockers and alpha, beta-blockers( 14.0% ).The control rate of hypertension in those hemodialysis people was aggravated by the existence of coronary artery disease.The patients who need more kinds of antihypertensive agents have a poorer control rate of hypertension.The hypertension control rate elevated significantly with the adequate hemodialysis.Conclusions There is a very high prevalence of hypertension in maintenance hemodialysis patients.Although the treatment rate is high, the control rate is unsatisfactory.So the control of hypertension in hemodialysis patient is still a clinical challenge.Appropriate dialysis adequacy, reasonable use of erythropoietin, treatment of heart disease and judicious use of antihypertensive drugs may be helpful to improve the clinical outcome.