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 analyze the clinical and pathological features of breast cancer in patients over 80 years old, to discuss the individualized treatment plan and further to provide foundation for clinical treatment . Methods Data of 58 breast cancer patients over 80 years old were retrospectively analyzed .They were treated from Jun.2008 to May.2014 and the diagnosis was confirmed by pathology after surgery .They were followed up by telephone.Results Among the 58 cases, invasive cancer accounted for 94.8%(55/58), in which triple-negative breast cancer accounted for 29.1%(16/55), and human epidermal growth factor receptor 2(HER2)pos-itive breast cancer accounted for 7.2%( 4/55 ) .Stage III breast cancer accounted for 24%( 14/58 ) .67.2%(39/58)patients underwent breast resection , 55.2%(32/58)patients underwent axillary treatment , 17.2%(10/58)patients received chemotherapy , and 51.7%(30/58) patients received endocrine therapy .Seven cases had recurrence and 3 cases died of the disease .Conclusions Breast cancer in elderly patients has its special clinical and pathological features .It has longer course , relatively late stage , and more complications .It has higher pro-portion of triple-negative breast cancer and lower proportion of positive HER 2.Elderly breast cancer patients are less tolerant to chemotherapy , thus surgery and endocrine therapy are the main treatment .

Brown-Sequard Syndrome ; etiology ; Cervical Vertebrae ; Humans ; Intervertebral Disc Displacement ; complications ; surgery ; Male ; Middle Aged

Objective To assess the value of endorectal elastography in the diagnosis of malignant rectal adenoma. Methods Sixty patients referred to the department of basic surgery of Peking Union Medical College Hospital for the evaluation of rectal adenoma from January 2011 to May 2013 were included in this prospective cohort. All patients underwent elasticity score (ES) and strain ratio(SR) examine before operation. To evaluate the reproducibility of the strain-ratio measurements, the intraclass correlation coefficient (ICC) was calculated. Compared with final operational pathological results,the diagnostic values of elasticity score and strain ratio method were assessed. Results Histopathological result showed there were 20 adenomas and 40 adenocarcinomas. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ERUS was 68%(27/40), 40%(8/20), 58%(35/60), 69%(27/39), 38%(8/21), respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of elasticity score was 85%(34/40), 70%(14/20), 80%(48/60), 85%(34/40), 70%(14/20), respectively. The SR of adenocarcinomas was significantly higher than that of adenomas(2.82±1.81 vs 1.23±0.57, t=3.333, P < 0.05). The differences among the SR of benign adenoma, benign adenoma with severe atypical hyperplasia and completely malignant lesions were statistically significant (1.26±0.84 vs 2.94±1.95, 1.42±0.55 vs 2.94±1.95, t=2.619, 2.415, P=0.013, 0.021). When 1.240 was chosen as the best cut-off value of SR, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of strain ratio was 82%(33/40), 75%(15/20), 80%(48/60), 87%(33/38), 68%(15/22), respectively. Conclusion Endorectal elasotgraphy can accurately diagnose the malignant rectal adenoma, which can provide reliable preoperative imaging evidence for clinical operation mode.

The objective of the study is to predict the spatial structure and B‐cell epitopes of Mycoplasma suis ORF5 pro‐tein .The secondary structure ,hydrophilicity ,flexible region ,antigenic index and surface probability were analyzed and predic‐ted by the Protean module in DNAStar software and B Cell Epitope Prediction Tools of IDEB ,then B‐cell epitopes were predic‐ted by aggregate analysis .Results showed that the secondary structure of Mycoplasma suis ORF5 protein was relatively regu‐lar ,in which the potential B cell antigenic epitopes were located at GGVDGGRD ,GMRLPEDSR ,and EGHPDLESAR .The methods of prediction of the secondary structure and B‐cell epitopes of Mycoplasma suis ORF5 protein may provide a new method for the study of M .suis immunogenicity ,and provides a new idea for the study on immunogenicity of pathogenic micro‐organisms .

Objective To investigate the morphological changes of the head,body and tail of the hippocampus in patients with Alzheimer's disease (AD).Methods Totally 30 AD (AD group),30 mild cognition impairment (MCI) patients (MCI group) and 30 normal old persons (normal control group) underwent brain MR scan.Based on the MR images,the head,body and tail of the hippocampus were segmented and the volume was measured.The difference of the volume in total,head,body and tail of hippocampus in AD group,MCI group and normal control group were compared.The correlation between hippocampal volume and the scores of neurological assessment scale was analyzed.Results The left total,head,body and tail volume were greater than those of the right side in 3 groups (all P＜0.05).For the comparison of total volume of left and right sides among the 3 groups,AD group was less than normal control group (both P＜0.01) and MCI group (both P＜0.05),MCI group was less than normal control group (both P＜0.05).Compared with the normal control group,the head,body and tail volume of hippocampus of both sides were decreased in AD group (all P＜0.05) and the volume of left head,body and right head of hippocampus in MCI group were decreased (all P＜0.05).Both sides hippocampus's head and body volume of AD group were less than those of MCI group (both P＜0.05).The scores of minimum mental state examination (MMSE) were positively correlated with the total and the head,body,tail volume of bilateral hippocampus.Except volume of left tail,there were negative correlations between the scores of activities of daily living (ADL),clinical dementia rating (CDR) and the volume of total and head,body,tail of bilateral hippocampus,which were positively correlated with Montreal cognitive assessment (MoCA) score.Conclusion The volume of bilateral hippocampus was significantly reduced in AD patients.The head of hippocampal volume was significantly reduced and the body and tail was not obvious.

Abstract: Objective　To evaluate the value of bronchoalveolar lavage fluid Aspergillus-specific fluorescent PCR assay combined with galactomannan (GM) assay in the diagnosis of patients with non-neutropenic invasive pulmonary aspergillosis (IPA). Methods From March 2022 to December 2023, 113 hospitalized patients with clinically suspected IPA were selected from the Zibo First Hospital of Zibo City, Shandong Province. Bronchoalveolar lavage fluid samples from each patient were simultaneously subjected to potassium hydroxide microscopy, fungal culture, GM assay, and Aspergillus-specific fluorescence PCR assay. According to the diagnostic criteria of IPA, patients were divided into clinically diagnosed IPA and non-IPA groups. The values of these four methods for the diagnosis of IPA were compared. Results According to the diagnostic criteria for IPA, 37 out of the 113 suspected patients were clinically diagnosed as IPA. The proportion of diabetic patients was significantly higher in the IPA group compared to the non-IPA group (χ2=7.494, P=0.006); similarly, the proportion of patients using glucocorticoids was significantly higher in the IPA group (χ2=6.981, P=0.008). Patients in the IPA group more frequently showed cavitation within consolidation areas on imaging, which was statistically significant (χ2=15.603, P<0.001). There were significant differences in the sensitivity of the four fungal detection methods in the diagnosis of IPA (χ2=45.803, P<0.001), with Aspergillus-specific PCR assay showing the highest sensitivity at 94.59%. Specificity also varied significantly across the four methods (χ2=31.511, P<0.001), with the highest specificity being seen in potassium hydroxide microscopy and fungal culture at 100.00%. There were significant differences in the clinical coincidence rate of the four methods in the diagnosis of IPA (χ2=11.768, P=0.008), with Aspergillus-specific fluorescence PCR assay having the highest coincidence rate at 90.27%. The AUC of the ROC curve of Aspergillus-specific fluorescent PCR assay combined with the GM assay was 0.976 7, higher than 0.913 8 by Aspergillus-specific fluorescent PCR assay merely. Conclusions The combination of Aspergillus-specific fluorescent PCR assay and GM assay using bronchoalveolar lavage fluid could significantly improve the accuracy of IPA diagnosis in patients without neutropenia.

Objective To establish a CVS-11 pseudovirus particles ( pp)-based assay for detec-tion of neutralizing antibody against rabies virus. Methods An improved rapid fluorescence focus inhibition test ( RFFIT) for detection of neutralizing antibody against rabies virus ( RVNA) was established based on the CVS-11 pseudovirus expressing a luciferase reporter gene. Forty-six human serum samples were analyzed with the improved RFFIT and the results were compared with those by using standard RFFIT. Moreover, the improved RFFIT was used to detect the titers of RVNA in 91 serum samples collected from pet dogs and pet-breeders in Beijing. Results The coincidence rate of the improved RFFIT and the standard RFFIT was 100% regarding to the analysis of 46 human serum samples and 5 negative reference serum samples. Moreo-ver, the RVNA titers of all serum samples obtained with CVS-11 pseudovirus-based assay showed a signifi-cant high correlation with those obtained with standard RFFIT (n=46, r=0. 94, P<0. 000 1). All of the 91 serum samples collected from pet dogs and pet-breeders in Beijing were positive for RVNA as indicated by the improved RFFIT with a mean titer of 33. 01 IU/ml. Conclusion We established an improved RFFIT based on the CVS-11 pp expressing luciferase reporter gene, which might be used as a reliable alternative RFFIT for measuring RVNA titer. Analysis of the 91 serum samples collected in Beijing with the improved RFFIT showed that all samples were positive for RVNA.

Objective To conclude and compare the technical characteristics and clinical efficacy of retroperitoneal and transperitoneal approach for robotic partial nephrectomy.Methods 418 patients received robotic partial nephrectomy conducted by one surgeon in the urology department of PLA General Hospital from 2013, December to 2015, October, including 157 cases in retroperitoneal approach and 261 cases in transperitoneal approach.There were no significant difference between the transperitoeal and retroperitoneal approach in patient age(51 years, 51 years, P=0.593), BMI(25.5 kg/m2,25.6 kg/m2, P=0.331), gender(male/female:111/46,186/75,P=0.184), location(left/right,80/77,123/138,P=0.575), tumor size(3.1cm,3.5cm,P =0.356), comorbidities, proportion of solitary kidney(11.5%, 9.6%,P=0.253) or bilateral tumors(1.3%,3.4%,P=0.179), RENAL score(6(5-8),6(5-8),P=0.083), ASA score(2 vs.2)(P=0.310) and preoperative serum creatinine(74.7 μmol/L,76.7 μmol/L, P=0.736).Patients in the retroperitoeal approach group were more likely to have abdomen surgery history (21.7%,14.2%,P=0.049).there was significant difference between two approaches in tumor location in the kidney ( anterior/posterior/others: 9/140/8, 212/36/13, P <0.001 ) Results The operation time (105min, 115min, P =0.041 ) and warm ischemia time ( 15min, 20min, P <0.001 ) were shorter and estimated blood loss(50ml,75ml,P<0.001) was less in the retroperitoneal group.No significant difference was observed in postoperative 24h blood loss(45ml,50ml,P =0.093), intraoperative transfusion rate (2.5%,6.5%,P=0.072) and collective system injury(24.8%,27.6%,P =0.539) between the two groups.Peritoneum break occurred in 25 cases in retroperitoneal group, which were repaired by Hem-o-lock.One intestinal injury occurred in transperitoneal group and was repaired intraoperatively.Three and nine cases in the retroperitoneal and transperitoneal group were converted to radical nephrectomy.One case in the transperitoneal group was found positive margin and received laparoscopic radical nephrectomy.Two liver injury and five spleen injury occurred in the transperitoneal group.For postoperative food intake(1 day, 2 days, P <0.001 ) , the length of indwelling drainage ( 3 days, 4 days, P <0.001 ) and the length of postoperative stay ( 5 days, 6 days, P =0.001 ) , the retroperitoneal group had one day shorter than the transperitoneal group.With the median following-up time of both group, 11 months (IQR:6-16) in RPRPN group and 12 months ( IQR: 7-19 ) , no subject with a tumor recovery or metastasis.Conclusions Retroperitoneal robotic partial nephrectomy is feasible and effective, which is similar to transperitoneal approach.The retroperitoneal approach is superior to transperitoneal approach for posterior, lateral and superior renal tumors.

Objective Survey of Guangxi Traditional Chinese Medicine hospital hand hygiene facilities at all levels was made with improvement measures proposed.Methods Hand Hygiene Norms for Medical Workers questionnaires designed by the Ministry of Health was used in a field survey on hand hygiene facilities of 89 TCM hospitals in Guangxi.Results Facilities of the non-hand-touch taps,hand sanitizer and hand disinfectants were found satisfactory at key departments at all TCM hospitals in the region,yet poor performance with the hand drying facilities.Hospitals with such departments with non-hand-touch taps,hand sanitizer and hand disinfectants accounted for 93.3％,100.0％ and 100.0％.Only 41.6％ of the hospitals were found to use dry hand towels as drying facilities.Significant difference was found at various levels of hospitals' hand hygiene facilities.Conclusion The hand hygiene facilities at such hospitals in Guangxi are receiving growing attention,yet further investment is still required for further improvement and compliance of the medical staff in hand hygiene.