Objective To study the clinical features and treatment of unilateral multicentric breast cancer.Methods The clinical data of 14 cases of unilateral multicentric breast cancer,which were found from July,2004 to December,2007 were analyzed retrospectively.ResultsSix cases(42.9%) had infiltrating lobular carcinoma,and the other 8 cases(57.1%) were invasive ductal carcinoma.The number of cancer focus was 2 to 9,and with a diameter of 0.5-4.3 cm.The focus in 12 cases were located in upper lateral quadrant;1 case was located in the upper medial and lateral quadrant;1 case was located in the upper lateral quadrants,the junction area of upper medial and upper lateral quadrants,and between upper lateral quadrant and lower lateral quadrants.One patient was treated by breast conservation operation,with no recurrence at 3-5 years follow-up;while the other 13 cases received modified radical operation,and with no recurrence at 2-37 months of follow-up.ConclusionsUnilateral multicentric breast cancer are often distributed in the same quadrant or adjacent quadrants of breast,and the majority cases are with invasive ductal carcinoma.For treatment of these lesions were a modified radical operation combine with comprehensive treatment.

Objective:To analyze the clinical data of primary hyperthyroidism patients complicated with thyroid microcarcinoma, and to guide clinical diagnosis and treatment.Methods:From January 2013 to March 2019, the clinical data of 42 cases of hyperthyroidism with thyroid microcarcinoma(study group) and 410 cases of thyroid microcarcinoma without hyperthyroidism(control group) who underwent surgical treatment in the People's Hospital Affiliated to Hubei University of Medicine were retrospectively analyzed.The epidemiological characteristics, clinical diagnosis and treatment, clinical stage, B-ultrasound characteristics, thyroid function and antibody, pathological data and prognosis of the two groups were compared.Results:In study group and control group, the proportion of microcalcification detected by B-ultrasonography was 61.9%(26/42) and 33.4%(137/410), respectively, the difference was statistically significant between the two groups(χ 2=13.411, P<0.05). In study group and control group, 47.62%(20/42) and 69.02%(283/410) of multifocal nodules were detected by B-ultrasound, the difference was statistically significant between the two groups(χ 2=7.899, P<0.05). The diagnostic rates of intraoperative frozen-section examination of the study group and the control group were 61.9%(26/42) and 66.1%(271/410), respectively, the difference was statistically significant between the two groups(χ 2=4.460, P<0.05). The lymph node metastasis rates of the study group and the control group were 9.5%(4/42) and 26.8%(110/410), respectively, the difference was statistically significant between the two groups(χ 2=6.049, P<0.05). The middle follow-up period was 37 months(1 month to 74 months). There was no recurrence of thyroid cancer in the study group, 2 cases with recurrence of hyperthyroidism after operation, and 3 cases with recurrence in the control group, with secondary surgical resection.There were no deaths in the two groups during follow-up. Conclusion:Thyroid cancer should be paid attention to when hyperthyroidism combined with nodules, but the prognosis of hyperthyroidism with microcarcinoma is better.The operation method tends to be bilateral lobectomy, which can prevent the recurrence of hyperthyroidism.In order to reduce the chance of parathyroid gland and recurrent laryngeal nerve injury, there may be no need of preventive lymph node dissection in area VI.

Objective To investigate the microbiological epidemiology and clinical use of antibiotics in patients complicated intra-abdominal infection (cIAI),therefore to optimize antibiotic use and to promote antimicrobial stewardship.Methods A total of 451 patients with cIAI from a Chinese tertiary hospital between January 2015 and December 2016 were retrospectively reviewed.The infection severity,timing of microbiological specimen sampling,culture results,initial antibiotic selection and later anti-infective regimen adjustment were analyzed.Results Three hundred and sixteen (70.1％,316/451) patients undergone microbiological investigation at infection sites within 3 days and 133 (42.1％) patients had a positive culture,of which 64.5％ were Enterobacteriaceae.Three hundred seventy-four patients (82.9％) initially received broad-spectrum antibiotics against gram-negative bacilli.Sixty-five patients (14.4％) initially received combined antibiotic therapy,of which 30.8％ were deemed as overuse.Among 308 patients who initially received broad-spectrum antibiotic therapy,268 patients (87.0％) clinically improved in five days,while de-escalation was only conducted in 72 cases (26.9％).On average,patients were treated with (2.29±1.30) antibiotics for a duration of (10.6±6.5) days,and 42.4％ received combined antibiotic therapy during hospitalization.Conclusions The major microbiological pathogens in cIAI patients in our hospital were Enterobacteriaceae.However,there are phenomena such as excessive usage with broad-spectrum antibiotics,insufficient awareness of de-escalation,and long course of anti-infective therapy,which needs to be further improved.

Objective:To explore the clinical efficacy of hip arthroscopy (HA) and periacetabular osteotomy (PAO) in the treatment of borderline developmental dysplasia of the hip (BDDH).Methods:The clinical data of 57 patients with BDDH treated with HA or PAO from July 2016 to June 2020 were retrospectively studied. According to surgical methods, they were divided into HA group and PAO group. There were 32 patients (6 males and 26 females) in HA group, with an average age of 34.5±6.4 years, ranging from 19 to 47 years. There were 25 patients (5 males and 20 females) in the PAO group, with an average age of 37.2±6.9 years, ranging from 21 to 50 years. Patients were followed up till May 2023. Imaging data of patients before the surgery and during follow-up were collected including lateral center edge angle (LCEA), anterior center edge angle (ACEA), extrusion index, T?nnis angle, femoral neck anteversion angle, and T?nnis grade. The modified Harris hip score (mHSS), non-arthritic hip score (NAHS) and hip outcome score activity of daily living scale (HOS-ADL) were evaluated at 6 months, 12 months and the final follow-up.Results:All patients were followed up for an average of 54.2±8.2 months in HA group and 55.5±9.4 months in PAO group separately. Before surgery, there were no significant differences in LCEA, ACEA, T?nnis angle, extrusion index, femoral neck anteversion angle and T?nnis grade between the two groups ( P>0.05). α angle of HA was 60.8°±5.8°, which was significant different from α angle of PAO 53.0°±5.9° ( t=5.07, P<0.001). At the final follow-up, in HA group, LCEA, ACEA, T?nnis angle, extrusion index were 20.0°±2.1°, 20.0°±2.6°, 30.6%±2.3%, 10.8°±1.6°, 39.8°±5.4, which were all significantly different from pre-operation data ( P<0.05). While there was no significant difference between pre- and post-operation in T?nnis grade (χ 2=5.72, P=0.057). In PAO group, LCEA, ACEA, T?nnis angle, extrusion index were 33.0°±3.0°, 33.3°±4.0°, 15.0%±4.0%, 2.8°±1.7° which were all significantly different from pre-operation data ( P<0.05). While there were no significant differences between pre- and post-operation in α angle and Tonnis grade ( P>0.05). Between HA group and PAO group, there were significant differences in LCEA, ACEA, T?nnis angle, extrusion index and α angle ( P<0.05), while no significant difference was found in T?nnis grade (χ 2=3.024, P=0.996). There were no significant differences between the two groups in preoperative mHHS, NAHS and HOS-ADL ( P>0.05). At 6 months,12 months and the final follow-up after operation, the mHHS, NAHS and HOS-ADL were significantly improved compared to pre-operation data ( P<0.05). At 6 months and 12 months after operation, the three hip function scores in HA group were significantly better than those in PAO group ( P<0.05). At the final follow-up, there was no significant difference in three hip scores between the HA group and the PAO group ( P>0.05). Conclusion:Both HA and PAO can achieve good short- and mid-term clinical efficacy in the treatment of BDDH. Specifically, HA is superior to PAO in the early clinical efficacy, and the mid-term clinical efficacy is similar. PAO is able to improve the acetabular radiographic parameters of BDDH (except α angle) while HA can only improve α angle. However, they all can effectively delay the imaging progression of hip osteoarthritis.

Objective:To evaluate the effectiveness of antimicrobial stewardship based on self-developed antibiotic clinical decision support system (aCDSS) in the inpatients at a tertiary hospital for consecutive 6 years, and to provide reference for rational use and antimicrobial stewardship.Methods:aCDSS was self-designed based on information technology and applied in clinical use in our hospital from 2015. Data of inpatient information and antibacterial use from January 2015 to December 2020 were collected from HIS and aCDSS. A retrospective study was conducted in all inpatients on the utilization rate and antibiotic use density.Results:Since 2015, with the comprehensive implementation of antimicrobial stewardship based on the aCDSS,there was a significant decline on the annual rate of antibiotic usage from 44.18% in 2015 to 38.70% in 2020, as well as on the usage rate of extended-spectrum antimicrobial agents including carbapenems, broad-spectrum β-lactam/β-lactamase inhibitors, tigecycline, broad-spectrum cephalosporins, fluoroquinolones, as well as glycopeptide and antifungal drugs. Compared with 2015, the usage of carbapenems, tigecycline and broad-spectrum β-lactam/β-lactamase inhibitors was declined nearly 50% in 2020, and the density of carbapenems and tigecycline were decreased by 29.6% and 7.1%, respectively in 2020. On the other side, the utilization rate and use density of narrow-spectrum cephalosporins continued to increase by year, the use density of narrow-spectrum cephalosporins accounting for 28.2% of all antibiotics in 2020.Conclusions:With the comprehensive implementation of aCDSS, the utilization rate and density of broad-spectrum and high-priced antibacterial drugs in our hospital have decreased continuously to decline in the past 6 years, while the proportion of narrow-spectrum antimicrobials has increased year by year, indicating that the structure of antimicrobial use has been continuously optimized and that antimicrobial stewardship based on the information technology have achieved remarkable results.