Objective To evaluate the inter-observer variability of static breast sonogram final assessment among observers with different breast imaging experience, using the first edition of the Breast Imaging Reporting and Data System(BI-RADS) for ultrasound. Methods Thirty patients with 30 breast lesions were included who underwent beast lesions resection operation. A pathological diagnosis was available for all 30 lesions:16 (53%) malignant and 14 (47%) benign. Twelve radiologists independently reviewed two sonograms of each lesion, and assigned a final BI-RADS assessment category. Inter-observer variability was measured using kappa statistic. Positive predictive value(PPV) and negative predictive value (NPV) for final assessment were also calculated. Results As for the experienced observers,kappa values of categories 3,4 and 5 were 0.72,0.28 and 0.60,NPV of category 3 was 93% ,PPV of category 5 was 97% ,all of which decreased as the breast imaging experience reduced. PPVs of categories 4a,4b and 4c were 56 % ,88% and 69%, respectively. Conclusions Using BI-RADS final assessment, radiologists with sufficient breast imaging experience can provide accurate and consistent assessment for breast ultrasonography,but the agreement of diagnosis decreased as the breast imaging experience reduced. The clinical feasibility of 4a,4b and 4c subcategories is uncertain.

[Objective] To investigate associations between the functional polymorphisms of signal transducer and activator of transcription 4 (STAT4) gene and unexplained recurrent spontaneous abortion (URSA) and between STAT4 protein expression and the genotypes of rs 10181656 locus.[Methods] PCR-restriction fragment length polymorphism was used to genotype rs 1 0181656 locus polymorphism in 332 URSA cases and 260 normal controls,in 86 URSA cases and 77 normal controls of which immunohistochemical technique was used to detect STAT4 protein expression.[Results] The frequencies of rs10181656 C/G were 36.45 ％,46.54％ in genotype C/C,46.99％,45.38％ in genotype C/G and 16.57％,8.08％ in genotype G/G between URSA patients and normal controls.They reached statistical difference (P ＜ 0.05).The carriers of rs 10181656 G allele increased the risk of URSA (OR =1.50,P ＜ 0.05).STAT4 protein expression in decidual tissues:①There was statistical difference in the STAT4 protein expression in decidual tissues between cases and controls (P ＜ 0.05).In URSA patients there was statistical difference in the STAT4 protein expression among genotype CC,CG and GG of rs10181656 locus (P ＜ 0.05).So was in normal controls (P ＜ 0.05).In genotype CC there was no difference in the STAT4 protein expression between cases and controls (P ＞ 0.05).Neither was In genotype CG and GG respectively (P all ＞ 0.05).[Conclusion] Functional polymorphisms of the rs10181656 locus could probably associate with the susceptibility of URSA via STAT4 protein expression increased by genotype G/G in maternal decidual tissue.

BACKGROUNDThe relationship between inflammatory markers and the characteristics of coronary atherosclerosis plaques is uncertain. The aim of the present study was to evaluate the relationship between the characteristics of coronary atherosclerosis plaques and inflammatory markers such as high sensitivity C-reactive proteins (Hs-CRP) and interleukin-6 (IL-6).

METHODSAll patients suspected of having coronary heart disease (CHD) underwent Siemens 64-slice CT angiography (64-SCTA) to distinguish the quality of plaque of coronary artery lesions. Blood samples were taken to measure levels of serum Hs-CRP and IL-6 in different plaque groups and the control group and compared with the value of 64-SCTA for detection of coronary artery plaque.

RESULTSThe sensitivity of detecting coronary artery plaque by 64-SCTA was 87.4%, the specificity was 87.1%, the positive predictive value was 82.2%, and the negative predictive value was 91.0%. Comparing the levels of serum Hs-CRP and IL-6 among plaque groups, the mean levels of serum Hs-CRP and IL-6 in three plaque groups were significantly higher than those in the control group (P < 0.01). The mean levels of serum Hs-CRP and IL-6 in the soft plaque group and mixed plaque group were significantly higher than those in hard plaque group (P < 0.01). Plaque burden in the soft plaque group and mixed plaque group was significantly higher than in the hard plaque group (P < 0.01), but there was no statistical difference between the soft plaque group and mixed plaque group (P = 0.246). There was a negative correlation between the CT scale and Hs-CRP and IL-6 levels in the soft plaque group (r = -0.621, P < 0.01, and r = -0.593, P < 0.01 respectively). There was a positive correlation between the plaque burden and Hs-CRP and IL-6 levels in the soft plaque group (r = 0.579, P < 0.05 and r = 0.429, P < 0.05 respectively).

CONCLUSIONS64-SCTA is an effective way to distinguish the different quality of coronary atherosclerosis plaque. Serum Hs-CRP and IL-6 levels can be considered as the indexes to judge the degree of CHD and may reflect the activity of plaque in CHD patients. Thus it is important for clinical diagnosis and risk evaluation of acute coronary syndrome (ACS) patients.

Aged ; C-Reactive Protein ; metabolism ; Coronary Artery Disease ; blood ; diagnostic imaging ; metabolism ; Female ; Humans ; Interleukin-6 ; blood ; metabolism ; Male ; Middle Aged ; Tomography, Spiral Computed

OBJECTIVETo investigate the feasibility and safety of autologous peripheral blood hematopoietic stem cell transplantation (auto-PBHSCT) and its therapeutic effect on refractory rheumatism among preschool children.

METHODSThree boys with juvenile rheumatoid arthritis (JRA), juvenile systemic lupus erythematosus (JSLE) and juvenile dermatomyositis (JDM) respectively, 3 to 6 years old with the mean age of 5 years with 3.5 to 22 months course of disease with 14 months on average, received auto-PBHSCT. Their conditions were so severe that conventional therapy failed to control the diseases. The changes of both clinical manifestations and immunologic indexes were observed before and after transplantation with long term following up at specialty clinic of rheumatism.

RESULTThe time when neutrophil count >or= 0.5 x 10(9)/L in the 3 children was days +9, +13 and +11 respectively, that of platelet count >or= 20 x 10(9)/L was days +14, +18 and +13 respectively. The cellular immune function remained abnormal with CD4 cells at a low level and CD4/CD8 being inverted. As to the JDM child, the skin rash had disappeared and his muscle tone was improved to grade 5 within one month after the transplantation. The EMG and serum creatase level returned to normal and muscle MRI findings were improved greatly within 2 months after the transplantation. As to the JSLE child, skin rash and proteinuria had disappeared, MRI of brain showed that the pathological changes had been absorbed and EEG returned to normal 3 months after the transplantation, all the autoantibodies turned to negative within 8 months after transplantation. As to the JRA child, the arthritis had been improved remarkably within 3 weeks after auto-PBHSCT. There was no swelling of joints nor movement limitation 3 months post transplantation. The steroids and immunosuppressive drugs were discontinued post transplantation. Cushing syndrome disappeared. Their body heights increased by 10 to 15 cm in the past 18 months, and they all returned to school. There was no relapse during follow-up periods of 25 - 27 months.

CONCLUSIONThe therapy with auto-PBHSCT for refractory rheumatism among preschool children was remarkably effective in a short-term, yet the safety and long-term effect still need to be further studied.

Child ; Hematopoietic Stem Cell Transplantation ; Humans ; Male ; Peripheral Blood Stem Cell Transplantation ; Rheumatic Diseases ; therapy ; Transplantation, Autologous ; Treatment Outcome

OBJECTIVETo investigate the method of the three-dimensional reconstruction of temporomandibular joint (TMJ) on the basis of CT and MRI medical image fusion technology, which establishes good foundation for a series biomechanical studies and clinical analysis.

METHODSThe geometric data for the TMJ model were obtained from a young and healthy male volunteer. Twelve spherical markers were located on the regions of both TMJ and mental tubercles, where CT and MRI scans can reach. The three-dimensional geometric of the hard and soft tissues of TMJ was reconstructed by CT and MRI scans data, which was based on the registration procedures of spherical markers located on the face of the volunteer.

RESULTSThe three-dimensional geometric model of TMJ was obtained, including hibateral articular disc, mandible, glenoid fossa and inferior teeth, and it had better geometric similarity. The results showed that the methods of three-dimensional reconstruction of TMJ with CT and MRI medical image fusion technology can be operated easily and promptly. The constructed model had good morphology.

CONCLUSIONIt is feasible to construct the three-dimensional model of TMJ on the basis of the registration procedures of spherical markers and CT-MRI medical image fusion technology. It has the advantage of simulating both hard and soft tissues reasonably. The model well expresses the shape of the TMJ.

Humans ; Magnetic Resonance Imaging ; Male ; Mandible ; Temporomandibular Joint ; Tomography, X-Ray Computed

OBJECTIVETo evaluate its mechanism of inducing the maternal-fetal immune tolerance by studying the effects of Shoutai pills on the expression of Th1/Th2 cytokine and pregnancy in maternal-fetal interface of mice with recurrent spontaneous abortion (RSA).

METHODThe normal pregnancy and RSA model were respectively induced with CBA/J x BALB/c and CBA/J x DBA/2. The mice with RSA were randomly divided into model group and low, middle and high dose groups of Shoutai pills. The mice were killed in 14 days after administration and embryo resorption rate was counted and their decidual and placental tissues were co-cultured to detect the expressions of IL-4, IL-10, IFN-gamma and TNF-alpha with ELISA.

RESULTThe embryo resorption rate of the model group was significantly higher than the normal pregnancy, middle and high dose groups of Shoutai pills could decreased the embryo resorption rate of the mice with RSA (P < 0.05). All the doses in 3 groups of Shoutai pills could decreased the expression of IFN-gamma and TNF-alpha (P < 0. 05) and there was no obvious difference between normal pregnancy group and all groups of Shoutai pills. Middle and high doses of Shoutai pills could increased the expression of IL-4 and IL-10 (P < 0.05) and there was no obvious differences between normal pregnancy and high dose group of Shoutai pills.

CONCLUSIONThe mechanism about Shoutai pills can change Th1 /Th2 cytokine towards Th2 bias, which induced the maternal-fetal immune tolerance.

Abortion, Habitual ; drug therapy ; immunology ; pathology ; Animals ; Cytokines ; immunology ; Drugs, Chinese Herbal ; administration & dosage ; Embryo Loss ; Female ; Humans ; Male ; Maternal-Fetal Exchange ; drug effects ; Mice ; Mice, Inbred BALB C ; Mice, Inbred CBA ; Mice, Inbred DBA ; Pregnancy ; Pregnancy Outcome ; Th1 Cells ; drug effects ; immunology ; Th2 Cells ; drug effects ; immunology

Adult ; Hepatitis B ; prevention & control ; Humans ; Immunity, Active ; Liver Transplantation ; immunology ; methods ; Male ; Postoperative Complications ; prevention & control

BACKGROUND: Preliminary experiments have confirmed that poly(hydroxybutyrate-co-hydroxyoctanoate) (PHBHOx)/collagen composite osteochondral scaffold exhibits desirable pore structure and biocompatibility. OBJECTIVE: To investigate the effect of PHBHOx/collagen composite osteochondral scaffold carrying bone marrow mesenchymal stem cells in the repair of articular osteochondral defects in the weight-bearing area of rabbits. METHODS: Cone-shaped osteochondral defects were created in the femoral medial condyle of the right knee of 30 New Zealand white rabbits. Then, the rabbit models were randomized into three groups and underwent implantation of PHBHOx/collagen composite osteochondral scaffold carrying bone marrow mesenchymal stem cells in the scaffold-cell group, PHBHOx/collagen composite osteochondral scaffold in the scaffold group and no intervention in the control group. At 4 and 12 weeks after surgery, animals were sacrificed for gross, Micro-CT, histological and immunohistochemical collagen II observations. RESULTS AND CONCLUSION: At 12 weeks after surgery, Micro-CT scanning results suggested that osteochondral defects were not repaired in the control group, repaired incompletely in the scaffold group with many new bone trabeculae, and repaired completely in the scaffold-cell group. Histological results showed that at 4 weeks after surgery, the defects in the control group were filled with amorphous tissues, subchondral bone formation just occurred in the scaffold group but increased in the scaffold-cell group. At 12 weeks after surgery, trabecular bone structure with no cartilage lacuna was observed in the control group; incomplete subchondral bone formation was observed in the scaffold group, and the cartilage layer was repaired by the fibrous tissues; in the scaffold-cell group, osteochondral defect repair was complete, with the emergence of tidal line, and the newborn cartilage was completely integrated with the surrounding normal tissue in addition to a similar thickness. At 12 weeks after surgery, collagen II basically did not express in the control group, weakly expressed in the scaffold group and highly expressed in the scaffold-cell group. In short, the PHBHOx/collagen composite osteochondral scaffold promotes the repair of articular osteochondral defects in the weight-bearing area.

OBJECTIVE: To compare and analyze the mechanical differences between single-row suture anchor fixation for repairing rotator cuff injuries and double-row suture bridges for repairing rotator cuff injuries from a biomechanical perspective. METHODS: The CT scan data of healthy adult shoulder joint were imported into Mimics, Geomagics and Hypermesh to carry out reverse reconstruction of two repair models, material assignment and mesh division, and the tearing of supraspinatus muscle was designed. After treatments, the load and boundary conditions were applied to the shoulder joint in ABAQUS software. The shoulder joint was fixed with four working conditions including flexion 15 °, flexion 30 °, internal rotation 15 ° and internal rotation 30 ° after anchor fixationand repair. The stress changes of the upper rotator cuff muscle and the anchor with thread were compared under these four conditions. RESULTS: Under the two flexion conditions, the stress of the supraspinatus in the double row suture bridge fixation model was 8.3% and 12% less than that in the single-row suture anchor fixation, respectively. Under the two internal rotation conditions, the stress of supraspinatus in the double row suture bridge fixation model was 47% and 48% less than that in the single row fixation repair model, respectively. CONCLUSION The "load sharing" effect between the two rows of four anchors makes the stress distribution more dispersed, increases the contact area between the supraspinatus muscle and the humerus, reduces the stress of the anchor, avoids the serious stress concentration phenomenon, and explains the advantages of the fixation method of the double row suture bridge from the biomechanical angle.
Adult ; Biomechanical Phenomena ; Cadaver ; Humans ; Rotator Cuff Injuries/surgery* ; Suture Anchors ; Suture Techniques ; Sutures

Objective To explore the application value of retrobulbar nerve block combined with general anesthesia in the penetrating keratoplasty (PKP). Methods A total of 100 recipients undergoing PKP from January 2017 to January 2019 were recruited in this study. All recipients were divided into the observation group (n=50) and control group (n=50) by random number table method. In the control group, patients received laryngeal mask airway under general anesthesia, and in the observation group, patients received laryngeal mask airway under general anesthesia combined with retrobulbar nerve block. Hemodynamic changes of the PKP recipients before and after operation were observed in two groups. The dosage of analgesic drugs and the incidence of complications were observed in two groups. The degree of pain at postoperative 2-, 6- and 24-h was evaluated by visual analogue scale (VAS) in two groups. The awakening situation of the recipients in two groups was observed. The levels of inflammatory cytokines at 1 d before and after operation were statistically compared in two groups. Results The average arterial pressure and heart rate at intraoperative 15 min and after the surgery in the observation group were significantly higher than those in the control group (both P < 0.05). In the observation group, the dosage of remifentanil and propofol were (1.0±0.4) mg and (299±40) mg, significantly lower than (1.3±0.6) mg and (365±42) mg in the control group (both P < 0.05). The incidence of complications did not significantly differ between two groups (P > 0.05). In the observation group, the VAS scores at 2-, 6- and 12-h after operation were remarkably lower than those in the control group (all P < 0.01). The respiratory recovery time, eye opening time, directional force recovery time and extubation time of the recipients in the observation group were significantly shorter than those in the control group (all P < 0.05). The expression levels of including interleukin (IL)-1, IL-6 and tumor necrosis factor-α (TNF-α) at postoperative 1 d in the observation group were considerably lower than those in the control group (all P < 0.05). Conclusions Retrobulbar nerve block combined with general anesthesia can maintain hemodynamic stability during PKP, reduce the dosage of remifentanil and propofol and alleviate the degree of postoperative pain and inflammatory responses of the recipients.