Objective To the value of ultrasonic imaging in diagnosis of appendiceal mucinous neoplasms in patients.Methods A retrospective review was performed for the 26 cases undergoing pre-operative ultrasonography and finally diagnosed as appendiceal mucinous neoplasms by pathology.The 26 patients were included in the study,11 elderly patients aged ≥60 years as group A,and 15 younger patients aged ＜ 60 years as group B.The characteristics of the ultrasonic imaging were analyzed.Results Features of ultrasound images leading to diagnosis were summarized as following.The lesion transverse diameter was over 2 cm,with anechoic or hypoechoic area of lesion or onion skin sign inside the lesions.There were distinct borderlines between lesions and surrounding tissues,with no or little blood in the color doppler flow imaging.Conclusions There are same u1trasonography characteristics of appendiceal mucinous neoplasms in two age groups.Improving the knowledge of this disease and grasping the clinical and sonography characteristics are stringent to enhance the accuracy rate of diagnosis.

Objective To investigate the effect of special CT monochromatic images on improving imaging quality in Budd-Chiari Syndrome.Methods 40 patients with Budd-Chiari Syndrome underwent CT venography (CTV)with gemstone spectral imaging (GSI).Using the optimal contrast to noise ratio (CNR)curve of GSI software,the optimal CNR monochromatic images of the infe-rior vena cava and hepatic vein were chosen.The CT value of the intrahepatic segment of inferior vena cava,hepatic vein and the same level liver tissue were measured,and the CT value of the same region were measured on 140 kVp mixed energy images and 70 keV images.CNR on the optimal monochromatic images,the 140 kVp mixed energy images and 70 keV images were calculated respectively,and the image quality of the optimal monochromatic image,the 140 kVp mixed energy images and 70 keV images were subjective scoring.One-way ANOVA was used for statistical analysis using SPSS1 7.0 software.Results The optimal keVs from monochromatic images were distributed at 40 keV (50%)and (5 1 ± 1 )keV (50%)for IVC and 40keV (25%)and (53 ± 3)keV (75%)for HV.The CNR and CT value and subjective score of IVC/HV got from the optimal monochromatic images were signifi-cantly higher than those from 140 kVp mixed energy images and 70 keV images respectively(P <0.01 ).Conclusion The optimal monochromatic images provide higher image quality of IVC and HV in patientswithBudd-Chiari syndrome.

ObjectiveTo investigate the features of normal and psoriasis skin on ultrasound biomicroscopy (UBM) and explore the method of thickness measurement.MethodsUsing 50 MHz ultrasound probe of biological microscope, ultrasonographic observation and ultrasonic thickness measurement were conducted in 90 normal adults and 40 psoriasis patients. Innormal patients, ultrasound evaluations were performed at 10 different parts of the body skin.ResultsOn sonogram, the normal skin showed a “sandwich” structure with two parallel hyperechoic bands and the middle isoechoic dots and short liens. The sonograms of the psoriasis skin showed obviously thickened epidermis and dermis, disordered internal structure and clear boundary from adjacent normal skin. The range of the epidermis’ thickness measurement was between the medial forearm (0.12±0.03) mm and the palm (0.29±0.15) mm. The range of dermal thickness measurement was between the back hand (1.18±0.32) mm and parasternal (1.55±0.21) mm. Psoriasis skin was thicker than the uninvolved skin (P<0.001). And the dermis’ thickness of uninvolved skin in psoriasis patients was thicker than that of the normal adults (P<0.001).ConclusionNormal adult’s epidermis, dermis and skin appendages can be shown clearly using 50 MHz ultrasound biomicroscopy. And ultrasound biomicroscopy canaccurately measure the thickness of dermis and epidermis, which provides the basis for the diagnosis and treatment of psoriasis.

Objective: To analyze the risk factors of positive vertical resection margin of the postoperative specimens after endoscopic treatment of rectal neuroendocrine tumors (NET). Methods: A case-control study was performed. Clinical data of patients with rectal NET (G1) undergoing endoscopic treatment between January 2015 and June 2018 at the Department of Gastroenterology, Beijing Tsinghua Changgung Hospital were retrospectively collected. Inclusion criteria: cases underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), whose mucosal specimens were pathologically confirmed as NET, and NET was confined to the rectum by nuclide imaging examination before endoscopic treatment. Those with incomplete clinical data or follow-up data were excluded. Resected specimen was fixed and sliced every 2 mm, and when tumor cells were found to infiltrate the vertical cutting edge, the positive vertical margin was defined. Associations of gender, age, resection method, tumor diameter, lesion morphology (nodular lesions, biopsy or post-treatment scar-like changes), mitotic figure, Ki-67 index, etc. and positive vertical margin were analyzed. Univariate analysis was performed using binary logistic analysis and multivariate analysis was performed using logistic regression model. Results: A total of 133 patients with rectal NET were enrolled, including 93 males and 40 females, with an average age of (50.0±10.7) years. Sixty-four patients received EMR treatment and 3 patients (4.7%) had positive vertical margins. While 69 patients received ESD treatment and 13 (18.8%) had positive vertical margins. After endoscopic treatment, 16 cases (12.0%) were vertical positive margin, including 11 males and 5 females with an average age of (52.4±10.4) years. The lesion diameter was (9.0±4.7) mm. Univariate analysis showed that lesion diameter ≥10 mm (χ²=5.575, P=0.018) and scar-like changes (χ²=3.894, P=0.048) were significantly associated with positive vertical margin. Multivariate analysis showed that the lesion diameter ≥10 mm (OR=10.136, 95%CI: 2.114 to 48.591, P=0.004) was an independent risk factor for positive vertical margin of the specimen after endoscopic treatment of rectal NET. Conclusion The diameter of rectal NET ≥10 mm indicates a high risk for positive vertical margin after endoscopic treatment.

Objective To compare the difference between color Doppler flow imaging (CDFI) and superb microvascular imaging (SMI) in the evaluation of vascular grading and the display rate of vascular in papillary thyroid carcinoma (PTC).Methods Between June 2015 and December 2015 in Beijing Chaoyang Hosptial,50 patients with 61 thyroid nodules were detected by ultrasonography,and pathologic types were confirmed as PTC.CDFI and SMI were used to evaluation the same nodule respectively according to Adler's grading criteria.The different flow characteristics were analyzed by the x2 test.Results In CDFI,the vascular grading of 33 patients were 0 ～ Ⅰ and these of 28 patients were Ⅱ ～Ⅲ by CDFI.In SMI,the vascular grading of 6 patients were 0 ～ Ⅰ and these of 55 patients were Ⅱ ～Ⅲ by SMI.There was a significant difference between CDFI and SMI for vascular grading (x2=27.475,P ＜ 0.01).In CDFI,50 patients with PTC showed punctiform and rod-like flow signals,and 5 patients showed more detail internal small branches by CDFI.In SMI,42 patients with PTC showed punctiform and rod-like flow signals,and 17 patients showed more detail internal small branches.There was a significant difference between CDFI and SMI about the display rate of vascular (x2=7.011,P ＜ 0.01).Conclusions Compared with CDFI,SMI is highly improved blood flow sensitivity.It can provide more detail internal small branches in PTC.The characteristics of vascular distribution are similar to strengthening mode of contrast-enhanced ultrasound in PTC,therefore,SMI is worth to further research.

Objective:To investigate the relationship between renin-angiotensin system (RAS) and bone mineral density in children with glucocorticoids-induced osteoporosis (GIOP) .Methods:From Apr. 2020 to May. 2021, 53 children with GIOP were recruited in the Children’s Hospital of Taiyuan Maternal and Child Health Hospital and included in the observation group, and 47 children who received glucocorticoid therapy but did not suffer from GIOP were included in the control group. The levels of serum RAS components and bone mineral density of the two groups of pediatric patients were detected and compared, and the risk clinical indicators affecting bone mineral density and GIOP were analyzed.Results:There were no significant differences between the observation group and the control group in terms of gender, age, BMI, disease type, type of glucocorticoid use, use of anti-osteoporosis (OP) drugs, expression levels of Angiotensin converting enzyme 2 (ACE2) or angiotensin II (Ang Ⅱ) (all P>0.05) . The bone density value of the observation group was lower than those of the control group, and the levels of angiotensin converting enzyme (ACE) (1.19±0.23) , angiotensin receptor 1 (AT1R) (1.24±0.24) , angiotensin receptor 2 (AT2R) (1.14±0.17) , and Mas receptor (MasR) (1.11±0.28) were significantly higher than those of the control group (1.00±0.23, 1.00±0.25, 1.00±0.21, 1.00±0.20) , and the differences were statistically significant (all P<0.05) . Pearson analysis showed that bone mineral density was negatively correlated with the levels of ACE ( r=-0.34, P=0.013) , AT1R ( r=-0.41, P=0.002) and AT2R ( r=-0.34, P=0.014) , and stepwise regression model showed that ACE ( t=-2.21, P=0.032) and AT1R ( t=-2.92, P=0.005) were the main factors affecting bone mineral density. Logistic regression model analysis showed that bone mineral density ( OR=0.85, P<0.001) , Ang Ⅱ ( OR=0.53, P=0.041) and AT2R ( OR=2.00, P=0.024) were independent clinical risk factors affecting GIOP (all P<0.05) . Conclusion:RAS components ACE and AT1R are independent risk factors affecting bone mineral density in children with GIOP, and are significantly correlated with bone mineral density in children.

OBJECTIVETo evaluate the efficacy and safety of trastuzumab plus different chemotherapy regimens in treatment of patients with HER-2-positive advanced breast cancer.

METHODS132 patients with advanced HER-2-positive breast cancer were treated with trastuzumab plus different regimens. The clinical characteristics, efficacy and toxicity of the 132 patients were retrospectively analyzed.

RESULTSFive patients had complete response (CR), 61 patients had partial response (PR), 39 patients had stable disease (SD), and 27 patients had progressive disease (PD). The objective response rate was 50.0% and the disease control rate was 79.5%. The median progression-free survival was 9.3 months. The median overall survival time was 46.2 months. The 1-, 2-, 5- year survival rates were 98.3%, 81.9% and 40.2%, respectively. Trastuzumab combined with chemotherapy is superior to trastuzumab monotherapy (51.2% vs. 33.3%). The number of metastatic sites, efficacy, different previous treatment lines were independent prognostic factors of PFS (P = 0.002, P < 0.0001 and P < 0.0001, respectively). Visceral metastases, pathological grade, and PFS were independent prognostic factors of OS (P = 0.041, P = 0.001, P = 0.025, P < 0.001, P < 0.0001 and P < 0.0001, respectively). Regarding the toxicities, one case discontinued treatment due to the decrease of left ventricular ejection fraction to 47%, two cases had heartbeat tachycardia, 6 cases had palpitation, 17 cases had a fever during first input trastuzumab. No other serious cardiac toxicity was observed. The most common toxicities were chemotherapy-related hematological and non-hematological toxicities.

CONCLUSIONSTrastuzumab combined with chemotherapy is superior to trastuzumab monotherapy. Patients may get benefits for early use of trastuzumab. Trastuzumab plus chemotherapy is effective and well tolerated in patients with advanced HER-2 positive breast cancer. No heart failure occurred in this series of patients, and cardiac safety seems better than that in Caucasians because of younger age at the onset in Chinese advanced breast cancer patients.

Adult ; Antibodies, Monoclonal, Humanized ; adverse effects ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Breast Neoplasms ; drug therapy ; metabolism ; pathology ; Carcinoma, Ductal, Breast ; drug therapy ; metabolism ; pathology ; Disease Progression ; Disease-Free Survival ; Female ; Fever ; chemically induced ; Follow-Up Studies ; Humans ; Middle Aged ; Neoplasm Grading ; Neutropenia ; chemically induced ; Receptor, ErbB-2 ; metabolism ; Remission Induction ; Retrospective Studies ; Survival Rate ; Taxoids ; administration & dosage ; Trastuzumab ; Vinblastine ; administration & dosage ; analogs & derivatives ; Vomiting ; chemically induced