Objective To analyze the clinical data,radiological and pathological features of breast cancer which were understated by image,and summarize the causes.Methods The clinical features,radiological features and pathological data of 26 cases of breast cancer were retrospectively analyzed.The preoperative ultrasound and mammography BI-RADS grades of these 26 cases were both ≤ 3,and they were confirmed to be breast cancer by pathology.The clinical and pathological data of 1224 cases of breast cancer in the same period were compared.Results For the 26 cases,100％ were early breast cancer,100％ were HER2 negative breast cancer,and only 1 case had lymph node metastasis.26％ were special type of breast cancer.Mammography showed glandular multi type,and ultrasound showed atypical or typical benign features.Conclusions Breast cancer understated by image shows features of young age,early stage,well differentiated,low malignant degree,not easy to be visualized by mammography,and their ultrasound features are usually atypical.In clinical setting,analysis of the ultrasound and mammography images should be combined with other examination,to decrease misdiagnosis rate.

Objective To evaluate the effects of right ventricular pressure load on left ventricular ( LV) myocardial mechanics using speckle tracking technology ,and to detect the change of LV function in patients with pulmonary hypertension( PH) at a earlier stage ,in order to provide reference for early clinical intervention . Methods The study included 74 patients with PH and 40 healthy volunteers ,who had of similar age and sex distribution . According to the pulmonary artery systolic pressure ( PASP) ,patients with PH were divided into mild ,moderate and severe groups ,which were marked with A ,B ,C , respectively . All subjects underwent echocardiographic examination . Conventional echocardiographic parameters ,the systolic longitudinal ,radial and circumferential peak strain ( LS ,RS ,CS) in various segments of LV ,as well as basal and apical segment myocardial rotation angle peak and peak time were determined ,LV systolic global longitudinal ,radial and circumferential strain (GLS ,GRS ,GCS) ,free wall (LAT ,lateral wall+ posterior wall) and interventricular septum ( IVS ,anteroseptal+ posteroseptal) overall LS ,RS ,CS were calculated . Results ①LVejectionfraction(LVEF):groupA,B,Chadnosignificantreduction(P>0.05)thanthe control group . ②Overall LS ,RS ,CS of LAT of LV and IVS and GLS ,GRS ,GCS of LV :B ,C group were lower than the control group and group A and C were lower than group B ( P < 0 .05) . ③ The rotation angle in ventricular apical basal segments and segment :group B and C were lower than the control group and group A and C were lower than group B ( P <0 .05) . ④GLS ,GRS ,GCS and overall LS ,RS ,CS of LAT and IVS were similar between group A and the control group( P >0 .05) ,but LV base segment rotation of groupAwaslowerthanthatofthecontrolgroup(P<0.05).Conclusions ①Rightventricularpressure overload can lead to increased LV mechanical damage ,LV strain changes were earlier than the change of LVEF . ②LV strain with increased right ventricular pressure overload is gradually reduced . ③Compared with other strain parameters , LV basal segments rotation angle were able to detect changes of LV myocardiol mechanics in patients with PH more sensitively .

As the urgent need of both clinic and research,the identification of hypertonia subtypes is becoming more and more important. Hypertonia assessment tool is a standardized discriminative measure with good reliability and validity. Hypertonia assessment tool can identify paediatric hypertonia subtypes. For its easily learning,it can be easily generalized in clinician.

Objective To investigate the value of color Doppler flow imaging(CDFI) in diagnosing lower limb artery in-stent restenosis (ISR), and to provide the evidences for clinical application. Methods Patients with lower limb artery percutaneous transluminal stent insertion in 12 months were enrolled in this study and divided into two groups, CT angiography (CTA) or digital subtraction angiography (DSA) was applied to diagnose ISR, 31 patients with 47 stenting which were diagnosed ISR was named as restenosis group, 63 patients with 89 stenting which were diagnosed no ISR was named as no stenosis group, and 30 normal person was enrolled and named as normal control group. Ultrasonic characteristics and peak systolic blood flow velocity (PSV), systolic blood flow acceleration time (AT) of proximal part, inner stents, distal part were recorded in restenosis group and no stenosis group, then compared with data in normal control group. Regression and receiver operator (ROC) curve were applied to analyse the correlation between PSV and AT. Results PSV of no stenosis group in common femoral artery, femoral artery, superifcial, popliteal artery stent respectively were (146.71±35.59) cm/s, (120.11±25.67) cm/s, (96.44±32.87) cm/s. PSV of normal control group in common femoral artery, femoral artery, superifcial, popliteal artery respective were (119.67±15.34) cm/s, (91.17±15.09) cm/s, (71.13±21.23) cm/s. There was statistically signiifcant difference between the two groups (t=2.457, 2.459, 2.321, all P<0.05). AT of no stenosis group in common femoral artery, femoral artery, superficial, popliteal artery stent respectively were (84.98±13.77) ms, (87.33±16.36) ms, (90.77±12.05) ms. AT of normal control group in common femoral artery, femoral artery, superficial, popliteal artery respective were (78.23±21.24) ms, (82.31±18.24) ms, (84.29±23.01) ms. There was no statistically signiifcant difference between the two groups (t=1.696, 1.904, 1.835, all P>0.05). PSV of restenosis group in proximal part, restenosis part, distal part respectively were (87.67±23.34) cm/s, (218.17±72.09) cm/s, (54.13±21.23) cm/s. PSV of no stenosis group in proximal part, inner stents, distal part respectively were (91.71±25.59) cm/s, (131.11±45.67) cm/s, (96.44±32.87) cm/s. There was statistically significant difference between restenosis part/inner stents, distal part (t=3.412, 3.511, both P<0.05). There was no statistically signiifcant difference between the two groups in proximal part (t=1.901, P>0.05). AT of restenosis group in proximal part, restenosis part, distal part respectively were (98.31±14.09) ms, (109.54±21.03) ms, (158.23±45.21) ms. AT of no stenosis group in proximal part, inner stents, distal part respectively were (84.98±13.77) ms, (86.34±19.36) ms, (83.77±17.05) ms. There was statistically signiifcant difference between restenosis part/inner stents, distal part (t=2.319, 3.610, both P<0.05). There was no statistically signiifcant difference between the two groups in proximal part (t=1.833, P>0.05). ROC curve showed that in ISR lower limb artery, PSV>168 cm/s had a sensitivity of 89.4%, speciifcity of 92.1%, the area under the ROC curve was 0.949;AT>127 ms, had a sensitivity of 86.8%, speciifcity of 98.0%, the area under the ROC curve was 0.867. Conclusions CDFI can detect the changes of PSV and AT, ISR can be detected and diagnosed earlier in lower limb artery. By combining PSV>168 cm/s with AT>127 ms, the value of ISR diagnosis can be increased.

Multiple cerebral infarction developed in a 36-year-old woman with adenocarcinoma of the right lung with direct cardiac invasion. Neurological examination and brain MRI showed findings of ordinary infarction. Transesophageal echocardiography showed left atrial pedunculated mass which was the potential source of embolism. We report a rare case who had such multiple spontaneous tumor emboli large enough to result in clinically detectable cerebral infarction.
Adenocarcinoma ; Adult ; Brain ; Cerebral Infarction* ; Echocardiography, Transesophageal ; Embolism ; Female ; Humans ; Infarction ; Lung ; Lung Neoplasms ; Magnetic Resonance Imaging ; Neoplastic Cells, Circulating ; Neurologic Examination

OBJECTIVETo develop a new experimental animal model of different a single perforating vessel as its pedicle, and to investigate this vessel can captures how many adjacent angiosomes in different directions.

METHODSThirty-six Sprague-Dawly rats of both sexes were used. The rats were divided into group A, group B and group C. Group A: the unilateral deep circumflex iliac perforator artery- based flap. Group B: the unilateral posterior intercostal perforator artery-based flap. Group C: the unilateral lateral thoracic perforator artery-based flap. An extended dorsal perforator flap measuring up to 13 cm x 6 cm was designed in 36 rats to assess the viability of the flap. The upper margin was located at the level of the tip of the scapula and the lower margin at a level 1 cm below the iliac crest. All flaps were observed for 7 days postoperatively, 72 hours after flap elevation, observe flap dyeing conditions through the vivo fluorescein injection, the surviving flap area was calculated as a percentage of total flap dimensions and the angiosome's structure of the flap was displayed by radiopaque microangiography.

RESULTSNo fluorescence was visible in the distal flap of groups A and C, the whole flap show bright fluorescence in group B. Survival rate of C, A, B were improved in order. Statistic difference is significant (P < 0.01) between group and group. In group A, lead oxide-gelatin angiography shows the cephalic flap necrosis occurred in the bilateral lateral thoracic territories, and the vascular architecture partly disappeared in the necrotic area. In group B, the vascular architecture of flap is unbroken. In group C, the caudal flap necrosis occurred in the bilateral deep circumflex iliac perforator artery territories, and the vascular architecture partly disappeared and disordered in the necrotic area.

CONCLUSIONSThe perforator flap is based centrally on a single perforator, this vessel can capture multiple the second vascular territory. In a direction, the longest distance that the blood supply can reach is the point of the third perforator vessel puncture into skin, which can provide certain theoretical guidance for designing of perforator flap.

Angiography ; Animals ; Female ; Graft Survival ; Male ; Models, Animal ; Perforator Flap ; blood supply ; Rats ; Rats, Sprague-Dawley

Aim To observe the protective mechanism of loganinand morroniside ( active components in Cornus officinalis) on HUVEC injury induced by advanced glycation end products ( AGEs ) .Methods HUVECs were cultured in vitro and divided into control group , model group ( AGEs group ) , loganin group , morroni-side group and aminoguanidine group ( set as positive control).After being incubated with loganin and mor-roniside( final concentrations were 100,10,1 μmol?L-1 ) for 1 h, HUVECs were stimulated by AGEs of 200 mg? L-1 for 24 h.Then, the cell viability was measured by using MTT method .The supernatant was extracted and the levels of NO ,ET-1,MCP-1,VCAM-1 were measured by the corresponding kits .Receptors of advanced glycation end products ( RAGE ) and NF-κB in HUVEC were detected by Western blot .Results Loganin and morroniside could inhibit HUVEC injury induced by AGEs .In model group ,the contents of ET-1,MCP-1,VCAM-1 increased(P<0.01),the content of NO decreased ( P <0.01 ) and the expression of RAGE and NF-κB increased(P<0.01); however,lo-ganin and morronside could reduce the ET-1,MCP-1, VCAM-1contents,increase the NO content and down-regulate the expression of RAGE and NF-κB to differ-ent extents .Conclusion Loganin and morroniside could ameliorate HUVEC injury , and its mechanism may be related to inhibit inflammation , the improve-ment of endothelial cell function , and the decrease of the expression of RAGE .

Objective To analyze the genomic sequences of Cryptococcus neoformans var grubii strains of two genotypes with different virulence and to screen out the virulence-associated genes. Methods A clinical strain (IFM56800) with the strongest virulence and an environmental strain (IFM56731) with the weakest virulence were screened out for whole genome sequencing analysis. The results of sequencing analy-sis were comprehensively analyzed by using the method of comparative genomics. Genetic variations were ex-tensively screened by using the strategies of non-synonymous single nucleotide polymorphisms ( nsSNPs), nonsense SNPs and the insertions or deletions ( InDels) causing frameshift mutations. The filtered genes were sequenced in 20 experimental strains. The whole RNAs were extracted and then the full-length cDNAs were sequenced by using the rapid amplification of 5′ and 3′ cDNA ends (RACE) method. Results By whole genome sequencing, valid data with high coverage (127 times and 111 times) was obtained in both the environmental strain IFM56731 and the clinical strain IFM56800. The data of InDels and SNPs were statisti-cally analyzed, respectively. Six genes were chosen for further analysis based on the strategies of nonsense SNPs and the InDels causing frameshift mutations. The six genes were amplified and sequenced in all of the experimental strains, three of which were further analyzed with cDNA sequencing. Ultimately, the location and structure of CNAG_01032 gene were determined. The predicted nonsense mutation locus was verified to present in the actual mRNA. Conclusion The strategies of nonsense SNPs and the InDels causing frame-shift mutations showed high-efficiency in screening potential virulence-associated genes. The CNAG_01032 gene was screened out as a novel virulence-associated gene.

Objective To investigate the correlation between serum cystatin-C (Cys-C) levels and cognitive impairment.Methods A perspective study involving 273 patients in our hospital was performed from 2013 to 2015.They were divided into the cognitive impairment group and the control group.Cys-C measurement results and cognitive impairment assessment scores were collected.Possible influence factors were adjusted,and the correlation between Cys-C levels and mild cognitive impairment was analyzed.Results The distribution of age,hypertension,diabetes mellitus,smoking,drinking,dyslipidemia,and creatinine showed significant differences between the groups at different Cys-C levels (all P＜0.05).There was a significant difference in the Cys-C level between the cognitive impairment group and the control group [(0.727±0.082) mg/L vs.(0.514±0.045)mg/L,t=23.68,P＜0.01].The Cys-C level was negatively correlated with the scores of mini-mental state examination (MMSE) and Montreal cognitive assessment (MOCA) in the cognitive impairment group (r =-0.318 and -0.572,P＜0.05).The incidence of cognitive impairment was elevated with increasing Cys-C levels (x2 =13.12,P＜0.01).Logistic regression analysis showed that high levels of Cys-C (OR=3.298,95％ CI:1.417-7.675,P=0.001),history of diabetes mellitus (OR=7.971,95％ CI:3.036-31.562,P =0.03),education level (OR =2.237,95 ％ CI:1.022-4.896,),smoking (OR =5.692,95 ％ CI:1.060-2.614),drinking (OR=1.227,95％ CI:0.083-1.228),and dyslipidemia (OR=2.267,95％ CI:1.177-4.366) are independent risk factors for cognitive impairment.Conclusions High serum cystatin C levels are closely correlated with the risk of cognitive impairment occurrence.

Objective To investigate the clinical treatment strategy of concomitant diseases and perioperation complications in elderly patients with hip fracture aged ≥ 80 years and the clinical prognosis.Methods A retrospective analysis was conducted in 95 hip fracture patients aged 80 and over years(80～90 years old) undergoing operation.There were 42 cases with femoral neck fractures and 53 cases with intertrochanteric fracture.71 cases (74.7％) had preoperative concomitant medical diseases.Screw fixation was performed in 3 cases (3.2％),hemiarthroplasty in 75 cases (78.9％),total hip replacement in 4 cases (4.2％),proximal femoral nail antirotation (PFNA) in 9 cases (9.5 ％) and reconstruction interlocking nail fixation in 4 cases (4.2 ％).Results No mortality was found during hospitalization.Postoperative anemia was the most common (74.7％),followed by hypoproteinemia (68.4％),digestive disorders (30.5％),electrolyte disturbance (28.4％) and psychiatric symptoms (15.8 ％).At least one-year follow-up was made in 73 cases.39 cases (53.4 ％) acquired independent activities after surgery,48 (65.8％) patients recovered to the preoperative level of activity.The concomitant diseases before surgery (OR =0.23,P =0.011),preoperative ability of activity (OR=0.23,P=0.025),the American Society of Anesthesiology (ASA) classification (OR=0.19,P=0.025) were the related factors influencing the one-year mortality.Conclusions The treatment of concomitant diseases should be emphasized in treating fracture.The active prevention during preoperative,intraoperative,postoperative period could reduce or avoid fatal complications and acquire good functions.