Objective To evaluate the ultrasonographic ( US ) findings of granulomatous lobular mastitis( GLM ) ,and to compare the diagnostic accuracy among US ,mammographic ,and magnetic resonance imaging ( MRI) . Methods Imaging characteristics of 56 patients who were pathologically comfirmed as GLM were reviewed .All the lesions were assessed by BI‐RADS ( Breast Imaging Reporting and Data System) . Results Fifty‐eight lesions were found in 56 patients . Thirty ( 51 .7% ) were irregular ,20 (34 .5% ) were lobular and 8(13 .8% ) were round or oval in shape . Forty two lesions (72 .4% ) were hypoechoic ,14 (24 .1% ) were mixed echoic textur ,including 6 lesions (10 .3% ) with tubular connections and 8 lesions ( 13 .8% ) with irregular markly hypoechoic internal echoes . Two ( 3% ) were isoechoic .No calcification were found . Color Doppler signals were detected in 33 cases(56 .9% ) ,and the resistance index ( RI) ranged from 0 .61 to 0 .79 . Forty patients underwent mammography ,there were no distinct lesions in 6 cases(15% ) ,suspicious calcification in two(5% ) , asymmetric density in twenty(50% ) ,and solitary masses in twelve(30% ) . MRI was performed in 36 patients ,and revealed no abnormality in two patients(5 .6% ) , twenty nine lesions ( 80 .6% ) showed hypointensity on T1‐weighted images and hyperimensity on T2‐weighted images ,five lesions ( 13 .9% ) showed isointensity on T1‐weighted images and hyperimensity on T2‐weighted images ,and all the lesions showed heterogeneous enhancement after contrast .The diagnostic accuracy of ultrasonography , mammography and MRl was 63 .8% , 45% and 61 .1% , respectively . Conclusions There were no specific imaging characteristics of GLM ,the combination of ultrasonography , mammography and MRI might benefit the diagnosis of GLM .

Objective To investigate the value of shear wave elastography (SWE)for differential diagnosis of benign and malignant thyroid nodules.Methods A total of 1 56 patients referred for surgery of thyroid nodules underwent standard ultrasound as well as elastography.The following characteristics of all the nodules were assessed:location,size,shape,margin,echogenicity,calcification and blood flow.The SWE elasticity indices of maximum (Emax),mean (Emean),minimum (Emin),and standard deviation (Esd) were automatically calculated by the US system.Thresholds were calculated by receiver operating characteristic (ROC ) curve analysis.The diagnostic performance of conventional US and SWE were compared.Histopathologic examination was used as the reference standard.Results Among a total of 1 56 nodules,1 1 8 were malignant and 38 were benign.SWE elasticity indices were significantly higher in malignant than in benign nodules (P ≤0.001 ).Sensitivity and specificity for predicting malignancy were 83.9%,92.1 % respectively using Emean with a threshold of 32.1 kPa,the specificity was significantly higher than using conventional ultrasound (P <0.05 ).Area under the ROC curve (Az)of Emean was highest (0.880,95% CI:0.81 7,0.943),however the differences were not significant(P >0.05).Conclusions SWE provides higher specificity for predicting malignancy without losing sensitivity.

Objective To analyze the ultrasonographic characteristics of breast cystic-solid lesions and to investigate the diagnostic value of BI-RADS breast imaging reporting and data system in this kind of disease Methods Imaging characteristics of 105 breast cystic-solid lesions of 93 patients were analyzed All the lesions were assessed by BI-RADS Histopathologic examination was used as the reference standard Results Among 105 lesions 57 54 3% were benign and 48 45 7% were malignant Differences in orientation shape margin calcification and vascularity were statistically significant between the benign and malignant lesions P < 0 05 whereas the echo pattern and the posterior acoustic feature did not show significant differences P >0 05).There were 5 1 predominantly solid mass,which appeared as solid mass with little dispersed or centralized cystic regions or solid mass with surrounding cystic regions,including 33 benign lesions and 1 8 malignant lesions.The area under the curves of ROC was 0.956 in this type.There were 25 lesions predominantly cystic,which had regular or irregular thick walls or septa,or had nodules protruding to the cystic component,including 1 1 benign lesions and 14 malignant lesions.The area under the curves of ROC was 0.753.There were 29 mixed solid-cystic mass,in which the solid component equaled to the cystic,including 13 benign lesions and 16 malignant lesions.The area under the curves of ROC was 0.887.The area under curves of ROC was 0.873 for the all breast cystic-solid lesions.The rates of malignant cystic-solid lesions in the three types had no significant difference(P >0.05).Conclusions Ultrasound is a useful tool for diagnosing breast cystic-solid lesions.The proportion of the cystic component is not helpful to differentiate malignancy from benignancy.

Adolescent ; Bronchoscopy ; methods ; Child ; Child, Preschool ; Female ; Fiber Optic Technology ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Pediatric ; Male

Abdominal Pain ; diagnostic imaging ; etiology ; Cholangiopancreatography, Endoscopic Retrograde ; Diverticulum ; diagnostic imaging ; Duodenal Diseases ; diagnostic imaging ; Female ; Humans ; Middle Aged ; Pancreas ; abnormalities ; diagnostic imaging ; pathology

Objective To investigate the epidemiological features of out-of-hospital cardiac arrest (OHCA) in Zhejiang and to analysis factors associated with outcomes for providing evidence on improving the success rate of cardiopulmonary resuscitation (CPR). Methods Clinical data of 493 patients with OHCA collected from the emergency department (ED) of Zhejiang Provincial People's Hospital, Ningbo Emergency Medical Service Center and Shaoxing Emergency Medical Service Center from January 2012 to August 2016 were analyzed retrospectively. All the data were recorded following the Utstein style included causes of arrest, location of arrest, first arrest rhythm, witnessed by bystanders, bystander CPR, pre-hospital defibrillation, pre-hospital intubation, pre-hospital epinephrine administration, emergency medical services (EMS) response time, return of spontaneous circulation (ROSC) at scene/enroute, ROSC at ED, admission to hospital, survival to hospital discharge and neurological outcomes at discharge. Factors associated with 30 days survival rate of patients with OHCA were analyzed. Results 493 patients were enrolled, of whom 342 were male and 151 were female. The average age was (58.8±21.4) years. The causes of arrests consisted of cardiac etiology (219 cases), trauma (155 cases), respiratory disease (22 cases), drowning (19 cases), electrocution (8 cases) and others (70 cases). Most of the events occurred at home (65.1%) and public places (22.7%). 55.2% patients were witnessed by bystanders while bystander CPR was performed in only 2.6% cases. Asystole was the predominant rhythm (78.7%) observed by the ambulance crew at the arrest site while only 5.5% first arrest rhythms were ventricular fibrillation/ventricular tachycardia (VF/VT). Only 6.9% patients underwent pre-hospital defibrillation. Pre-hospital intubations were attempted in 16.4% patients. Epinephrine was administered in 56.4% patients at scene or in ambulances. EMS response time was (13.6±8.0) minutes. 4.5% patients had ROSC at scene/enroute and 7.7% had ROSC at ED. Only 9.7% patients were admitted to hospital and 1.2% discharged alive. 0.8% patients were still in hospital on 30th day. The 30-day survival rate was 2.0% (10/493) and only 0.8% patients had neurologically favorable survivals [with the cerebral performance category (CPC) score of 1 or 2]. Witnessed by bystanders (3.31% vs. 0.45%), VF/VT as the first arrest rhythm (7.41% vs. 1.72%), bystander CPR (15.38% vs. 1.67%), pre-hospital defibrillation (8.82% vs. 1.53%) and EMS response time < 10 minutes (3.57% vs. 0.74%) could improve 30-day survival rate of OHCA significantly (all P < 0.05). Conclusion Resuscitation survival of OHCA in Zhejiang province was unsatisfactory. Improvements are required in series aspects of OHCA survival chain.

BackgroundRecent studies showed that diabetic retinal neuropathy is an earlier and more dangerous complication and neurotrophin has a protective effect on retina.ObjectiveThe present study was to observe the changes of brain derived neurotrophic factor (BDNF),its receptor TrkB,signal pathway protein phosphatized extracellular signal-regulated protein kinase1/2 (p-ERK1/2) and c-fos in the retina after injection of BDNF into the vitreous in STZ induced Wistar diabetic rats.MethodsWistar rats aged 9 weeks-old were randomly divided into BDNF injection group,diabetes mellitus (DM) control group and normal control group and 20 rats for each group.STZ was intraperitoneally injected in the rats of BDNF injection group and DM control group to create the experimental DM.BDNF was intravitreously injected in the rats of BDNF group 2 weeks after administration of STZ in three-day interval for 5 times,and BSS containing O.1％ bovine serum albumin (BSA) was used at the same way in the DM control group and normal control group.The retina was isolated for hybridization in situ for BDNF,and TrkB,p-ERK1/2 and c-fos.Levels in retina were detected using sandwich method ELISA.ResultsThe number of BDNF positive cells and the gray scale were lower obviously in the rat retina of DM control group than those of BDNF injection group and normal control group,showing significant differences among the 3 groups ( F =102.36,92.55 ;P＜0.05 ).ELISA assay showed that TrkB,p-ERK1/2 and c-fos values in retina were statistically significantly different among the 3 groups ( F =92.54,95.46,94.84,P＜0.05 ).The TrkB level in retina was statistically reduced,but the p-ERK1/2 and c-fos levels in retina were increased statistically in DM control group compared with BDNF injection group and normal control group( P＜0.05 ).No statistical difference was found in TrkB,p-ERK1/2 and c-fos values between the BDNF injection group and normal control group(P＞0.05).ConclusionsThe injection of BDNF into the vitreous cavity can protect retina from downregulating BDNF and TrkB levels and up-regulating the p-ERK1/2 and c-fos protein levels in the early stage of DM.

Objective To explore the prognostic effect of fluid-attenuated inversion recovery imaging vascular hyperintensity (FVH)on intravenous thrombolysis of acute ischemic stroke.Methods We retrospectively reviewed the clinical and imaging data of intravenous thrombolytic patients with acute anterior circulation infarction admitted from May 2009 to December 2013.The presence of FVH was evaluated,and its associations with reperfusion and clinical outcome after thrombolysis were assessed.Results Ninety-three patients were analyzed.FVH was detectable in 55 (59.1％) cases.Patients with FVH had higher NIHSS scores (11.8 ± 6.0 vs 7.2 ± 4.5,P ＜ 0.01),larger initial DWI lesions (5.5 ml vs 2.0 ml,Z =-3.030,P=0.002) and perfusion lesions (42.0 ml vs 3.0 ml,Z=-6.104,P =0.005),compared with those without FVH.The history of hyperlipidemia (OR =0.264,95％ CI 0.07-0.90,P =0.048) and proximal large vessel occlusion(OR =48.874,95％ CI 11.6-205.924,P ＜ 0.01) were independently associated with the presence of FVH.The presence of FVH independently predicted the poor neurological outcome at 3 months (OR =4.143,95 ％ CI 1.440-11.919,P =0.008).However,early reperfusion was associated with favorable outcome in patients with FVH after intravenous thrombolysis (OR =8.500,95％ CI 1.964-36.790,P =0.004).Conclusions The presence of FVH is associated with proximal large vessel occlusion,which predicts poor outcome in patients with intravenous thrombolysis.However,early reperfusion among patients with FVH can improve the outcome.

Objective To construct and screen a hepatic stellate cells(HSCs) subtracted cDNA library, in order to seek differentially expressed genes in mice infected with Schistosoma japonicum. Methods HSCs were isolated from mouse as targets, and cDNA fragments of normal mouse were compared to those of S.japonicum infected mice to find differentially expressed genes by technique of suppression subtractive hybridization(SSH). Differentially expressed cDNA fragments were then directly inserted into T/A cloning vector to set up the subtractive library. Amplification of the library was carried out with transformation of DH5?. A subtracted cDNA library was constructed and then hybridized with forward and backward subtracted probes for differential screening. One hundred positive bacterial clones were randomly selected for sequencing and BLAST analysis. Finally, virtual Northern blot confirmed such differential expression. Results The amplified library contained more than 400 positive bacterial clones. Random analysis of 100 clones with restriction enzyme digestion showed that all clones contained 200-600 bp inserts. 76 ESTs were obtained with 70 related to fibrosis caused by schistosomiasis or other etiological factors. Other 6 ESTs were not found in PubMed. Conclusion The subtracted cDNA library of differentially expressed genes of HSC in normal mice and schistosome-infected mice was constructed successfully with SSH and T/A cloning techniques.