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

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.

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.

Objectives To investigate the relationship of sex difference with serum bisphenol-A (BP-A),adiponectin and metabolic syndrome (MetS)in elderly patients with isolated systolic hypertension(EISH).Methods A retrospective study of the clinical data was conducted in 540 subjects from the Cardiology and Geriatric Department in the Affiliated Hospital of Shanxi Medical University,Changzhi Municipal People,s Hospital and the Department of Cardiology of Shanxi Medical University,First Clinic Hospital from January 2010 to December 2013.Elderly patients with EISH were divided into male group(n=270)and female group(n=270).Meanwhile 560 older health persons were severed as controls,including 300 females and 260 males.The changes of BP-A and adiponectin (Ad) concentration were measured.The blood lipid,insulin resistance index (HOMA-IR),blood pressure,body mass index,heart rate variability and ultrasonic change of heart and blood vessel were tested regularly.Results The level of serum BP-A[(0.89±0.10)ng/L vs.(0.57±0.04)ng/L]and [(0.64±0.10)ng/L vs.(0.55 ± 0.08)ng/L] were higher in male EISH vs in male control,and in female EISH than in female control (F =23.76,23.86,all P ＜ 0.01),respectively.The levels of adiponectin were lower in male EISH vs control[(4.9±1.4)ng/L vs.(10.5±2.7)ng/L and in female EISH vs control(6.0±1.3) ng/L vs.(11.5±3.3)ng/L),F=13.10,16.20,all P＜0.01.Root mean sequare of the successive normal sinus RR interval difference(rMSSD)were lower in male/ female EISH than control groups(F=13.10、13.70,P ＜0.01).Serum BP-A level was positively correlated with the bocly mass index and systolic pressure (r =0.38,0.54,P ＜ 0.01),and was negatively correlated with serum Ad and rMSSD(r=-0.46,-0.42,P＜0.01).Conclusions Obvious gender difference in changes of serum BP-A exists in older patients with EISH.Network cytokines may take part in the pathophysiological process of the obesity related hypertension.

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 To evaluate postprandial pharmacokinetics and bioequivalence of two preparations of cefdinir capsules in Chinese healthy volunteers. Methods In a two-way cross-over study, 24 healthy male volunteers were divided into two groups randomly and a single dose of cefdinir capsules of test and reference preparation were administered orally, respectively.The concentration in plasma was determined by LC-MS/MS. Pharmacokinetic parameters and bioequivalence were calculated and evaluated by DAS. Results The main pharmacokinetic parameters of test and reference were as follows: AUCt (4.35±1.09) μg??h??mL-1 and (4.12±1.22) μg??h??mL-1, AUC0-∞(4.53±1.12) and (4.53±1.73) μg??h??mL-1, t1/2 (1.74±0.29) h and (2.13±1.65) h, tmax(4.44±0.86) h and (4.54 ±1.16) h, Cmax(900±250) ng??mL-1 and (876±269) ng??mL-1 . Conclusion The test and reference preparation of cefdinir capsules are bioequivalent.

Objective To provide a basis for humanity education in the university by a survey of clinical graduates' recognition of humanity education and humanity curriculum. Method An anony-mous questionnaire was adopted and 514 questionnaires were distributed to the 2014 clinical gradu-ates in Peking University Health Science Center about their understanding of humanity education and humanity curriculum. The investigation data was double entried in Epidata 3.1, apply SPSS 19.0 to make the descriptive analysis, chi-square test. Results 69.3% (167/241) students believed humanity education enhanced their professionalism and competency;52.7%(127/241) students believed humanity education enhanced their doctor-patient communication; 36.4% (174/478) students believed their hu-manity knowledge came from their instructors' personal example and teaching;31.1%(149/479) students said the best way of humanity education was through social practice;59.7%(286/479) students consid-ered the combination of classroom lecturing and discussion as the best way to humanity education. As to the major weaknesses in humanities education, 46.9%(113/241) students chose insufficient curriculum, 23.2%(56/241) chose lack of practical value and 23.7%(57/241) chose monotonous teaching methods;Conclusion The best approach to humanities teaching is to combine class lecture with class discus-sion. Besides, hidden curriculum also contributes to humanity education. The enhancement of clinical graduates education relies heavily on humanity education and its emphasis should be laid on the training of humanity teachers, the study of humanity curriculum and learning from other universities.