Objective:To observe the effect of local excision under ultrasonography with immediate mammoplasty in granulomatous lobular mastitis.Methods:Fifty-three patients with granulomatous lobular mastitis admitted from Jan 2017 to Jul 2020 were retrospectively analyzed. Combined with sonographic findings and clinical manifestations, patients were divided into four types: type Ⅰ, single mass; Type Ⅱ, single mass located in one quadrant with one or no skin lesion; Type Ⅲ, multi-quadrant involved with one or no skin lesion; Type Ⅳ, multiple abscesses with multiple lesions in the skin. Twenty-five patients underwent wide local excision (control group); Twenty-eight patients underwent local excision under ultrasonography with immediate mammoplasty (experiment group). Patients with erythema nodosum or in type Ⅳ were given antibiotics and corticosteroid therapy preoperatively for 1 week and postoperatively for 5 days. The others went straight to surgery.Results:All patients were followed up for 1 year. In the experiment group, 28 patients had primary wound healing, and 3 patients had poor wound healing after operation (all were of type Ⅳ). The control group had 6 cases of recurrence(were of type Ⅲ and type Ⅳ). There was significant difference of the recurrence rate between the two groups (0 vs. 24%, χ 2=6.033, P=0.014), and the aesthetic effect of local excision under ultrasonography with immediate mammoplasty was better than that of wide local excision(93% vs. 68%, χ 2=5.330, P=0.020). Conclusion:The recurrence rate of local excision under ultrasonography with immediate mammoplasty is low, and with a satisfactory cosmetic effect.

Objective:To evaluate the effect of high-flow nasal cannula (HFNC) oxygen on the early respiratory distress in patients with acute paraquat poisoning.Methods:This prospective study included patients who were hospitalized in the Emergency Department of First Hospital of China Medical University diagnosed and were diagnosed with acute PQ poisoning from May 1, 2017 to May 1, 2018. Inclusion criteria: acute PQ poisoning patients with dyspnea, and meet the following conditions: dyspnea with RR > 25 beats/min or PCO 2 < 32 mmHg. The following information were recorded: RR, SpO 2, HR and MAP before and 15 min, 30 min, 1 h, 2 h, 4 h, 6 h, 12 h and 24 h after HFNC application, as well as and arterial blood gas before and 6 h, 24 h after HFNC application. The improvement of RR, SpO 2, HR, MAP, PCO 2, PO 2, pH and Lac were compared before and after HFNC. Mann-Whitney U rank test and Chi-square test were used and a P<0.05 was regarded as statistically significant. Results:A total of 50 patients were included in the study. After 28 days of follow-up, 26 patients survived and 24 died. There was no difference between the two groups in gender and age. There were differences in PQ oral doses, urinal PQ concentration, Lac and PaCO 2 between the two groups. HFNC significantly reduced the RR and HR of all patients at all time points, and PaCO 2 was significantly increased at 6 h after application, 36 mmHg(34, 38) mmHg vs 30 mmHg (27, 32) mmHg ( P<0.05), while MAP, SpO 2, PO 2, and pH had no significant differences. RR and HR of the survival group were significantly lower than those of the non-survival group, as well as the maximum flow rate, 35 L/min (25, 40) L/min vs 55 L/min(50, 60) L/min ( P<0.01). Conclusions:HFNC can significantly reduce the early respiratory frequency and heart rate of patients with acute PQ poisoning and improve dyspnea. Meanwhile, it can significantly reduce the patients' oxygen consumption and improve the relative or absolute hypoxic state of patients after poisoning.

Objective:To analyze the clinical symptoms and laboratory characteristics of patients with brucellosis combined with osteoarthritis.Methods:A retrospective analysis was conducted on the medical records of 168 patients with brucellosis who were hospitalized at the Jining Public Health Medical Center, Shandong Province from January 2021 to December 2022. Based on the imaging examination results, they were divided into combined osteoarthritis group and non combined osteoarthritis group. The demographic characteristics, clinical symptoms, and laboratory test results of the two groups of patients were compared and analyzed.Results:Among 168 patients with brucellosis, there were 83 patients with concurrent osteoarthritis, 85 patients without concurrent osteoarthritis, the males and females ratio was 2.73 ∶ 1.00 (123 ∶ 45), and the age was 56 (46, 64) years old. The median age of patients in combined osteoarthritis group was higher than that of patients in non combined osteoarthritis group (58 years vs 53 years, Z = - 2.89, P = 0.004). In clinical symptoms, the incidence of back pain, fatigue, and joint muscle pain in patients of combined osteoarthritis group was significantly higher than that in the non combined osteoarthritis group [75.9% (63/83) vs 56.5% (48/85), 30.1% (25/83) vs 15.3% (13/85), 47.0% (39/83) vs 17.6% (15/85), χ 2 = 7.07, 5.27, 16.58, P < 0.05]. In laboratory tests, the erythrocyte sedimentation rate (ESR) and hypersensitive C-reactive protein (hs-CRP) levels in patients of combined osteoarthritis group were higher than those in the non combined osteoarthritis group [27.0 (17.0, 34.0) mm/h vs 21.0 (10.5, 34.0) mm/h, 22.7 (14.3, 43.4) mg/L vs 17.9 (10.8, 34.2) mg/L, Z = - 2.51, - 2.00, P < 0.05]. Among patients with combined osteoarthritis, combined spondylitis accounted for the highest proportion (55.4%, 46/83), followed by peripheral arthritis (51.8%, 43/83). Conclusion:Osteoarthritis is a common complication of brucellosis, and patients of brucellosis with concurrent osteoarthritis have clinical features such as lower back pain, fatigue, and joint muscle pain, with significantly elevated of ESR and hs-CRP level.

OBJECTIVETo investigate the efficacy and safety of inhaled iloprost on top of other pulmonary hypertension (PH) specific therapies for patients with PH and severe right heart failure.

METHODSWe consecutively enrolled WHO functional class IV patients with PH and chronic thromboembolic pulmonary hypertension (CTEPH) in Shanghai Pulmonary Hospital from January 2011 to January 2013. Inhaled iloprost was administrated to all enrolled patients, oral endothelin antagonist receptors (ERAs) and/or type 5 phosphodiasterase inhibitors (PDE5-I) were also used as basis therapies. The in-hospital outcomes and the changes of right heart functional parameters were observed.

RESULTSTwenty-four patients with PH and 5 patients with CTEPH were enrolled. After a mean treatment duration of (23 ± 13) days, 3 patients dead and significant improvement was observed in the remaining 26 patients. Compared with the baseline, heart rate decreased from (99 ± 14) to (91 ± 12) bpm (P = 0.001), plasma NT-proBNP level decreased from 5 823 (3 029-13 248) to 3 220 (1 678-6 720) ng/L (P < 0.001), tricuspid annular plane systolic excursion (TAPSE) increased from (1.3 ± 0.4) to (1.4 ± 0.3) cm (P = 0.018), right ventricular diameter decreased (left-to-right diameter from (57 ± 11) to (53 ± 10) mm, P = 0.040, and superoinferior diameter from (69 ± 11) to (64 ± 16) mm, P = 0.027), Tbil also decreased from (41 ± 34) to (26 ± 17) µmol/L (P < 0.001). No severe side effects were observed.

CONCLUSIONThe strategy of inhaled iloprost on top of other PAH-specific target therapy medications is effective and safe for PH patients with severe right heart failure.

Objective To estimate the treatment effect of a tumor necrosis factor ? alpha antagonist (etanercept) on Stevens?Johnson syndrome induced by drugs. Methods After exclusion of tuberculosis, hepatitis, severe infections and tumors, 17 patients with drug?induced Stevens?Johnson syndrome were treated with subcutaneous injections of 25 mg(initial dose, 50 mg)etanercept once every 3 days for 6 times. Meanwhile, supportive therapies and compound glycyrrhizin injections were given to counteract inflammation and protect the liver. Results All of the patients were cured. Body temperature in 15 febrile patients gradually decreased within 24- 48 hours after the first injection of etanercept, and returned to normal in 72 hours. The number of vesicles stopped increasing, and lesion color turned from bright red to dull red within 24 hours. Skin condition was evidently controlled within 72 hours, and skin appearance almost returned to normal after 2 weeks of treatment, and was completely restored after 4- 5 weeks. The recovery of mucous membrane was slower than that of skin. Serum aminotransferase levels gradually declined after the first dose of etanercept and almost returned to normal in 2-4 weeks in 14 patients. Serum levels of urea nitrogen and creatinine began to decrease after 1- 2 weeks of treatment. The serum level of tumor necrosis factor?alpha nearly dropped into or was maintained in the normal range within 3 weeks after the start of treatment. Conclusion Early usage of tumor necrosis factor?alpha antagonists at an adequate dose is beneficial to the rapid control of Stevens?Johnson syndrome.

Objective To investigate the clinical implications of serum tenascin-C (TNC) levels for lung injury and the prognosis in acute paraquat (PQ) poisoning patients.Methods Clinical data of acute PQ poisoning patients hospitalized in Emergency Department of First Hospital of China Medical University from January 1 to December 31,2017 were prospectively collected.Patients' serum samples were obtained on admission and serum TNC levels were quantified by a commercially available enzymelinked immunosorbent assays (ELISA) kit.Patients were followed up to 28 d after poisoning and divided into the survival and non-survival groups.The differences of clinical data together with serum TNC level between the two groups were analyzed by univariable analysis.The correlation between serum TNC level and liver function,renal function and artery blood gas results was analyzed.Logistic regression analysis was used for assessing the independent risk factors of death.ROC curves of related parameters were plotted and the area under the curve (AUC) was calculated.Results Eighty-two patients were enrolled in this study:35 patients in the non-survival group and 47 patients in the survival group.There was no significant difference of data on admission between the two groups,including pH,PaO2,Cr,BUN,ALT,TBil,AMS,TNC,lung CT positive rate.But PaCO2,Lac,urine paraquat concentration and serum TNC level on admission were significantly different between the survival and non-survival groups.Furthermore,serum TNC level was correlated significantly with the worst PaO2 value,pH,and lung CT positive rate within 72 h from admission,especially the worst PaO2 value (r=-0.801,P＜0.01).Logistic regression analysis showed that the serum TNC level on admission was an independent risk factor for the prognosis of acute PQ poisoning patients.The AUC was 0.895 and the cutoff value was 41.9 ng/mL.Conclusion The early serum TNC level in acute PQ poisoning patients can predict the degree of lung injury and evaluate the prognosis.

Objective:To develop and validate an clinical prediction model for the risk of breast cancer-related lymphedema (BCRL).Methods:Breast cancer patients who were prepared to undergo axillary lymph node dissection were propsectively enrolled, indocyanine green combined with Photodynamic Eye (PDE) was applied to reveal the arm lymphatic flow . The arm lymphatic fluorescence images were collected to calculate the proportion of arm lymph flow above and below the axilla vein. Volumetric measurements of both arms and subjective questionnaire were performed to evaluate the occurrence of lymphedema. A difference in volume between the arms >10% was defined as lymphedema. Univariate logistic regression analysis was used to analyze the relationship between each factor and BCRL. The stepwise forward method was used to include multiple factors in the logistic regression analysis to establish the prediction model.Results:Three hundred and twelve patients were enrolled. Fourty-five (14.4%) patients developed BCRL. Using the coefficients obtained from multivariate analysis, BMI ( OR 95% CI: 1.34 (1.25-1.77), P<0.05), chemotherapy ( OR 95% CI: 2.26 (1.97-2.63), P<0.05), regional lymph node radiotherapy ( OR 95% CI: 1.59 (1.05-2.41), P<0.05) and the proportion of arm lymph flow above the level of the axillary vein ( OR 95% CI: 0.70 (0.68-0.81), P<0.05) were identified as independent predictive factors for BCRL, and the following prediction equation was derived: Y=0.369×(BMI at surgery)+0.713×(taxane-based chemotherapy)+0.862×(radiotherapy)-9.058×(proportion of the arm lymph above the axillary vein)-6.859 8. The ROC curve was screened to the optimal boundary value of 0.118 6 by the Youden's index. The sensitivity, specificity, positive predictive value and negative predictive value of prediction of this model were 93.3%, 79.4%, 73.3%, 98.6%, respectively. Conclusion:With the guidance of the predictive model, particular patients who need the preservation of axillary lymphatic system can be identified, and timely intervention can be carried out.

Objective:To investigate the correlation of atrophy and intestinal metaplasia (IM) stage with gastric cancer and to optimize biopsy strategy.Methods:Data of patients who underwent endoscopy and five-point biopsy at Shandong Provincial Hospital between November 2020 and October 2022 were collected. The baseline characteristics of gastric cancer and non-gastric cancer patients, as well as the occurrence and severity of atrophy and IM in different areas were compared. Logistic regression analysis was used to evaluate the correlation of operative link for gastritis assessment (OLGA) and operative link for gastric intestinal metaplasia assessment (OLGIM) staging with gastric cancer. The Kendall tau correlation coefficient was used to compare the consistency of different biopsy strategies (two-point, three-point, and four-point) with the standard five-point biopsy in OLGA and OLGIM staging. Receiver operating characteristic (ROC) curve analysis was further performed to compare the diagnostic performance of different biopsy strategies in identifying the OLGA and OLGIM Ⅲ-Ⅳ stage.Results:A total of 122 patients were included in the analysis, with age of 61.0±10.0 years. Multivariate analysis showed that OLGA staging was not associated with gastric cancer ( P=0.788), while OLGIM Ⅲ-Ⅳ staging was significantly correlated with gastric cancer ( P=0.006, OR=3.39, 95% CI: 1.41-8.17). The occurrence of atrophy and IM were higher in lesser curvature of the antrum [56.6% (69/122) and 66.4% (81/122)] and incisura angularis [57.4% (70/122) and 52.5% (64/122)], with higher severity, while lower in greater curvature of the corpus [2.5% (3/122) and 5.7% (7/122)], with lower severity. The consistency of four-point and three-point biopsies with standard five-point biopsy in OLGA and OLGIM staging was high. The consistency of three-point biopsy in incisura angularis, lesser curvature of the antrum and corpus was exceptionally high among them, with correlation coefficients of 0.969 and 0.987, respectively. Conclusion:OLGIM Ⅲ-Ⅳ stages increase the risk of gastric cancer. Three-point biopsy in incisura angularis, lesser curvature of the antrum and corpus are recommended for the screening and monitoring of atrophy or IM.

Objective: To investigate the efficacy and safety of the recombinant human tumor necrosis factor receptor Ⅱ-IgG Fc fusion protein (rhTNFR: Fc, etanercept) for the treatment of occupational medicamentosa-like dermatitis induced by trichloroethylene (OMLDT) . Methods: In September 2011 to February 2016, 12 patients with OMLDT were treated with etanercept 25 mg, subcutaneous injection, twice per week, doubling of first dose. The course of treatment was 6 weeks. The drug eruption area and severity index (DASI) score, the proportion of patients achieving a 50%, 75% and 90% reduction in DASI (DASI50, DASI75, DASI90) and the serum level of TNF-α were used to assess the efficacy at different times. Adverse reactions were also recorded and evaluated. The results were statistically analyzed by nonparametric Friedman test and repetitive measurement ANOVA using the software SPSS19.0. Results: After 4 weeks treatment, the DASI score decreased form 56.33±7.02 to 0.50±0.91 (P<0.01) . The DASI50, DASI75 and DASI90 were all increased to 12 (100%) . The serum level of TNF-α decreased form (43.74±41.62) pg/ml to (3.03±0.47) pg/ml (P<0.01) . Statistically significant difference was observed from the above indexes. There were no adverse reactions in clinical application. Conclusion Recombinant human tumor necrosis factor receptor Ⅱ-IgG Fc fusion protein may be a safe and effective drug in the treatment of OMLDT.

Objective:To analyze the long-term outcomes of different secondary surgeries in women with recurrent stress urinary incontinence (SUI) after Burch colposuspension.Methods:Between February 2004 to February 2010, five women with recurrent SUI after Burch colposuspension in Peking Union Medical College Hospital were retrospectively followed up, and the long-term outcomes of secondary surgeries were analyzed. Subjective cures of Burch colposuspension and secondary surgeries were assessed by patients′ self-reported incontinence symptoms and patient global impression of improvement questionnaire; objective cure, improvement or failure were determined by 1-hour pad test.Results:Three women underwent tension-free vaginal tape-retropubic (TVT) as the secondary surgery, one underwent tension-free vaginal tape-obturator (TVT-O), and one underwent single-incision tension-free vaginal tape-Secur (TVT-Secur). The follow-up period of five women was (14.6±2.4) years (range: 10.8 to 16.9 years). Three women undergoing TVT secondary surgery were subjectively cured; while the other two women undergoing TVT-O or TVT-Secur were not subjectively cured, but the woman undergoing TVT-O was objectively improved.Conclusions:It is feasible for women with recurrent SUI after Burch colposuspension to receive the secondary surgery. Our limited data suggests that TVT could be considered.