Objective To investigate the distribution characteristics and clinical features of familial aggregation hemangioma to improve the level of the diagnosis and treatment.Methods Total 1202 cases of vascular disease were treated in this department from June 2006 to June 2011.The clinical data and family distribution characteristics in 36 cases of familial aggregation hemangioma were analyzed and their effects of laser treatment were evaluated.Results 36 cases were familial aggregation hemangioma,whose incidence was 2.99 ％ in 1202 cases of vascular disease cutis; and the ratio of male to female was 1 ∶ 1.There were 9 cases of parents suffering from hemangioma.But the incidenceof the next generation suffering from vascular disease was 28.5 ％.Among these 36 cases of familial aggregation hemangioma,33 cases underwent the long pulse 1064 nm Nd ∶ YAG laser and optimized pulse light combination therapy.The effective rate was 100 ％.Conclusions There may be a genetic predisposition in hemangioma.The application of long pulse 1064 nm Nd ∶ YAG laser and optimized pulsed light treatment to hemangioma cutis can obtain satisfactory results.The intervention should be taken in early stage.

Objective:To investigate the differential diagnosis of MRI between male malignant and benign breast lesions.Methods:Totally 34 patients with male breast lesions who underwent breast MRI examination from January 2011 to March 2019 were collected from Shanghai Cancer Center.All images were evaluated by two radiologists who were blinded to pathological results. When there was a disagreement, another independent senior radiologist assessed the imaging features. The imaging features including lesion location, T 1WI signal, T 2WI signal, lesion type and accompanying signs were evaluated. All lesions were confirmed by biopsy or surgical pathology. Twelve patients were in benign group, 22 patients in malignant group. The imaging findings of MRI were recorded and statistically analyzed by univariate analysis (continuous variables were tested by Mann-Whitney U test and categorical variables were tested by Fisher′s exact test). Results:Among the 34 patients, 31 cases clinically touched the mass and 3 cases showed simple nipple bleeding. In MRI signs, breast cancer showed mass-like enhancement (22/22), benign lesions showed non-mass enhancement (7/12), the difference was statistically significant ( P<0.05). And ipsilateral axillary enlarged lymph nodes only appeared in breast cancer, which was significantly different from that in benign lesions ( P<0.05). There was no significant difference in age, lesion location, T 1WI signal, T 2WI signal, skin thickening and nipple invagination between benign and malignant lesions. There was no significant difference in the size, shape and edge of the mass between benign and malignant lesions on MRI ( P>0.05). Conclusions:MRI can distinguish male malignant and benign breast lesions. Most of non-mass enhancement are benign lesion and enlarged lymph nodes are helpful to detect breast cancer, nipple retraction and skin thickening in the diagnosis of male breast cancer are limited.

Objective To investigate the correlation factors for surgical outcome of sacral decompression and lumbopelvic fixation in H-shaped sacral fracture and the methods to prevent and treat the complications.Methods From January 2008 to January 2016,45 patients with H-shaped sacral fracture treated by sacral decompression and lumbopelvic fixation were respectively analyzed,including 29 men and 16 women,mean age 41.2 (range,24-53 years),mean follow-up time 52.6 months (range,16-93 months).The surgical outcome was evaluated by pelvic outcome score,and correlation factors were analyzed.We analyzed whether each factor was in correlation with pelvic outcome score.Then we integrated the statistically significant indicators into Logistic regression equation to determine the related factors.Postoperative complications were all recorded.Results The average operation time was 161.2 min (range,100-220 min),average blood loss was 491.6 ml (range,370-1 000 ml),injury-surgery interval was 7.2 d (range,1-23 d).In terms of pelvic outcome score,31 (68.9％) patients had satisfactory result and 14 (31.3％) patients had unsatisfactory result.Univariate x2 analysis suggested that cauda equina injury,Roy-Camille classification,L5S1 facet injury,fracture line,kyphotic angle,injury-surgery interval,decompression approach and inserting sacral screws were correlated with pelvic outcome score,but gender,age,injury mechanism and L5 pedicle fracture had no relation with pelvic outcome score.The multivariate Logistic regression analysis showed that cauda equina injury,Roy-Camille classification,fracture line,kyphotic angle,injury-surgery interval,decompression approach and inserting sacral screws were closely related to pelvic outcome score,but L5S1 facet injury was excluded.2 patients required early surgical procedures with proper antibiotics for deep wound infection;3 patients complained pain related to hardware prominence and the pain subsided after removal of implants;1 patient got unilateral rod breakage at 3-6 months and achieved bony fusion after nine months of observation.Conclusion Sacral decompression and lumbopelvic fixation is effective in neurological recovery and early ambulation in treating H-shaped sacral fracture.Better surgical outcome is related to timely surgery,preoperative or intraoperative bone traction,sacral screws insertion,incomplete cauda equina injury,Roy-Camille type Ⅱ,fracture line penetrating S2 and kyphotic angle less than 40°.

ObjectiveTo investigate the histological features as well as the factors influencing liver disease progression in Chinese patients with chronic hepatitis C (CHC). MethodsA total of 102 CHC patients who underwent percutaneous liver biopsy between August 2007 and May 2010 were recruited. Age, gender, body mass index (BMI) and transmission route of recruited patients were recorded. Serum levels of alanine transaminase (ALT) and aspartate transaminase (AST), HCV genotypes, HCV viral load and liver histological changes were detected. Statistical analysis was done by t test and Logistic regression. ResultsThe serum levels of ALT and AST in CHC patients with histological activity index (HAI) ≥4 were much higher, while platelet (PLT) counts were lower than those with HAI ＜4(t=2.209, 2. 298 and 2. 565, respectively; all P＜0.05). Likewise, in patients with F≥3, the serum levels of ALT and AST as well as the mean age and the duration of infection were significantly elevated compared with F ＜ 3 group ( t = 3.497, 2. 758, 2. 340 and 2. 570,respectively; all P＜0. 05), while PLT counts were much lower (t = 2. 761, P=0. 007). The unvariate predictors for HAI≥4 were female, ALT＞1 × upper limits of normal (ULN), AST level,F≥3, HCV RNA≥6 lgIU/mL and PLT counts. By mutivariate analysis, the Ishak stage score was the only independent predictor for HAI≥4 (OR 3.098, 95％CI 1.884-5. 092; P＜0.01). Finally,the univariate predictors for F≥3 were age, BMI≥24 kg/m2 , ALT＞1 × ULN, AST level, HAI≥4,PLT counts and duration of infection≥ 15 years. Multivariate analysis revealed that age (OR 1. 074,95％CI 1.006-1. 146; P=0.033), ALT level (OR 1. 035, 95％CI 1.015－1.055; P＜0.01), ASTlevel (OR 0. 969, 95％CI 0. 948－0. 990; P=0. 005), the duration of infection ≥15 years (OR 37. 215, 95％CI 5. 816－238. 127; P＜0.01) and HAI≥4 (OR 1. 939, 95％CI 1. 426－2. 636; P＜0.01) were independent predictors for F≥ 3. ConclusionAge, ALT level, AST level, duration of infection≥15 years, HAI≥4 are independent predictors for liver fibrosis.

Objective To evaluate the clinical outcomes of sacral decompression and lumbopelvic fixation for neurologically impaired patients with sacral fracture-dislocation.Methods From January 2009 to December 2013,32 patients with sacral fracture and spino-pelvic dissociation of Roy-Camille types Ⅱand Ⅲ were treated at our department.They were 21 men and 11 women,with a mean age of 34.3 years.According to Roy-Camille classification,9 patients belonged to type Ⅱand 23 to type Ⅲ;25 patients had S1 fracture-dislocation and 7 S2 fracture-dislocation.After their overall conditions were stabilized,all were treated with open reduction,sacral decompression and lumbopelvic fixation.Pre-and post-operative neurological functions were recorded by Gibbons criteria.We analyzed the correlations between the neurological recovery and (i) the extent of cauda equina deficit and (ii) the continuity of sacral roots,as well as the correlations between the functional recovery of the bladder and bowels and the above two.The reduction and fusion status were evaluated by the Mears and Velyvis radiological criteria;clinical effectiveness was evaluated by Majeed scoring system.Intra-and post-operative complications were all recorded.Results The mean follow-up time for this series was 35 months (from 25 to 47 months).The average Gibbons score improved from 4.0 to 2.7 at the follow-ups.The patients with mild cauda equina deficit or with continuity of sacral roots achieved significantly better neurological recovery than those with severe cauda equina deficit or with discontinuity of sacral roots (P ＜ 0.001).However,the functional recovery of the bladder or bowels was not significantly correlated with the extent of cauda equina deficit or with the continuity of sacral roots.Anatomical reduction was achieved in 26 patients,satisfactory reduction in 5 and unsatisfactory reduction in one,yielding a satisfaction rate of 96.9％.Bony fusion was obtained in 29 patients at 3 months,but not until at 9 months in 2 patients,and still not at 9 months in one who showed no symptoms.The Majeed scoring showed 22 excellent,6 good and 4 moderate cases,giving an excellent to good rate of 87.5％.Two patients developed deep wound infection,3 complained of the pain related to hardware prominence,and one had unilateral rod breakage.Conclusions In treatment of sacral fracture with spino-pelvic dissociation,sacral decompression and lumbopelvic fixation can lead to effective neurological recovery,restoration of lumboscacral stability and alignment,early ambulation and prevention of deformity.Complete neurological recovery is more likely in patients with incomplete cauda equina deficit or with continuity of all sacral roots.

Life-limiting fetal condition (LLFC) is a devastating event for the entire family, and it can also cause work distress and negative emotions for healthcare workers. The implementation of high-quality perinatal palliative care (PPC) can help pregnant women and families cope with the pain caused by trauma and maximize the quality of life and comfort of the fetus. Perinatal palliative care knowledge, skills, and attitudes of health care workers are closely related to the quality of palliative care services and maternal and infant outcomes. This article summarizes the knowledge, skills, and attitude assessment tools of perinatal palliative care of health care workers, in order to provide a reference for the development of perinatal palliative care assessment tools suitable for China.

Objective:To explore the associations of urinary retinol binding protein (RBP) and β 2-microglobulin (β 2-MG) with urinary albumin to creatinine ratio (UACR) and renal function in hospitalized patients with type 2 diabetes mellitus (T2DM). Methods:A total of 1 030 Chinese patients with T2DM were included in this study. The subjects were divided into the UACR normal group (<30 mg/g), microalbuminuria group (30-300 mg/g) and macroalbuminuria group (>300 mg/g). Patients with normal UACR were further divided into two groups according to the estimated glomerular filtration rate (eGFR): the eGFR low group (<90 ml·min -1·1.73m -2) and the normal eGFR group (≥90 ml·min -1·1.73m -2). Urine RBP and β 2-MG levels among the groups were compared. Multiple linear regression analyses were applied to evaluate risk factors of urine RBP and β 2-MG. Results:In all patients ( n=1 030), urine RBP and β 2-MG increased gradually with the increase of UACR across the three groups, the proportions of abnormal urine RBP (>0.7 mg/L) and β 2-MG (>370 μg/L) in these groups were 3.8%, 8.5%, 39.0% ( P<0.001), and 12.9%, 26.7%, 46.8% ( P<0.001), respectively. In the UACR normal group ( n=788), 12.2% of the patients were with eGFR<90 ml·min -1·1.73m -2. The proportion of abnormal β 2-MG (>370 μg/L) was higher in the eGFR low group than that in the eGFR normal group (29.2% vs. 10.7%, P<0.001). Multivariate linear stepwise regression analyses were performed using natural logarithm of urine RBP or β 2-MG as dependent variable, and showed that urine RBP was independently associated with UACR ( β=0.0005, P<0.001), serum creatinine ( β=0.006, P<0.001) and glycosylated hemoglobin A1c ( β=0.050, P=0.001), and β 2-MG was independently correlated with UACR ( β=0.000 4, P<0.001), serum creatinine ( β=0.011, P<0.001), systolic blood pressure ( β=0.005, P=0.031) and fasting blood-glucose ( β=0.027, P=0.046). Conclusions:Urine RBP and β 2-MG are positively associated with high UACR and impaired renal function in T2DM patients, and these changes could occur before UACR and eGFR turned out to be abnormal. It is recommended that urine RBP and β 2-MG be detected as early as possible to identify diabetic kidney disease in patients with normal UACR and eGFR.

Objective To measure the expression of circulating microRNA (miRNA)in patients with hepatitis B virus (HBV)-related liver failure and its relationship with disease prognosis.Methods The miRNA expressions in serum of 5 patients with HBV-related liver failure and 5 healthy control subjects were compared using Exiqon miRCURY LNATM miRNA microarray.The sera from 20 patients with chronic hepatitis B (CHB),20 patients hepatitis B related cirrhosis,50 patients with HBV-related liver failure and 40 healthy persons in Ruijin Hospital were collected.The relative expression of miRNA-595 was measured using quantitative real-time polymerase chain reaction (PCR).The relative expressions of miRNAs among groups were analyzed using student t test,the correlations were analyzed by Pearson and Spearman correlation.Results Microarray informed that 92 miRNAs changed significantly in patients with HBV-related liver failure,and miRNA-595 increased most significantly.The results of real-time PCR showed that the relative expressions of miRNA-595 ,miRNA-300 and miRNA-122 were 6.03 (t=3.134, P =0.003),3.12 (t=7.221 ,P <0.01)and 2.77 (t=2.671 ,P =0.021),which were higher compared to those in healthy control group.In the analysis of the relationship between miRNA-595 expression and disease prognosis in patients with HBV-related liver failure,the relative expressions of miRNA-595 in patients with CHB,hepatitis B related cirrhosis and HBV-related liver failure were 2.26 (t =3.780,P =0.001),3.32 (t = 6.111 ,P < 0.01)and 6.03 (t = 3.134,P = 0.003),respectively,which were all increased compared to that of the healthy control.The relative expression of miRNA-595 of patients with HBV-related liver failure was 2.66 times (t=2.450,P =0.043)higher than that of patients with CHB. When dividing patients according to prothrombin activity,miRNA-595 increased significantly in patients with early stage liver failure.When dividing patients according to model of end-stage liver disease (MELD) score,MELD score was positive correlated with the expression of miRNA-595 when MELD score was under 30 (r=0.673,P =0.004).The expression of serum miRNA-595 in survival group (11 .08,n=23) was higher than that in non-survival group (3.67,n = 27,t =4.309,P =0.041).Conclusions The expressions of miRNA595 ,miRNA-300 and miRNA-122 are all increased in patients with HBV-related liver failure,especially the expression of circulating miRNA-595 at early stage of the disease.The miRNA-595 may be used as a new serum biomarker for monitoring the severity of disease.

Objective To investigate the inhibition effect of liraglutide (lira) on high glucose-induced adhesion of endothelial cells to monocyte.Methods Human umbilical vascular endothelial cells (HUVECs) induced by high glucose (20 mmol/L) were incubated with different concentrations of liraglutide (0,0.3,3,30 nmol/L) for different time.THP-1 cells were pre-labeled with Calcein-AM and then incubated with HUVECs for 1 h,M199 medium were used for washing the nonadherent cells for 3 times,and the adhesion of HUVECs to THP-1 cells were measured by Fluorence microplate reader;real-time polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assay (ELISA) were employed to detect the mRNA and protein expression of vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1),respectively.Western blot was used to measure the content of IκBα,p-IκBα and the distribution of p65 in plasma and nuclear.GST-IκBα was introduced as substrate to test the activity of IκB-kinase (IKK).Results The adhesion of HUVECs to THP-1 (P ＜ 0.01),the mRNA and protein expression of VCAM-1 and ICAM-1 (P ＜ 0.05,P ＜ 0.01),the phosphorylation of κBα (P ＜ 0.05,P ＜ 0.01),the translocation of p65 subunit from plasma to nuclear and the activity of IKK (P ＜ 0.01) in HUVECs were all elevated by stimulation with 20 mmol/L glucose,and the content of IκBα was decreased accordingly (P ＜0.01).Pre-incubation with lira could reverse the above effect of high concentration of glucose.Conclusions Lira could reduce VCAM-1 and ICAM-1 expression through IKK/NF-κB pathways in 20 mmol/L glucose-induced HUVECs,which finally suppress THP-1-HUVECs adhesion.

Objective:To investigate the efficacy and safety of different doses of rivaroxaban in the treatment of lower extremity deep venous thrombosis after catheter directed thrombolysis.Methods:Clinical data of 92 patients with lower extremity deep venous thrombosis received catheter directed thrombolysis at Nanjing Drum Tower Hospital from Jun 2017 to Dec 2018 were collected and analyzed. Patients were divided into Rivaroxaban group (10 mg qd), Rivaroxaban group (20 mg qd) and Warfarin group according to the anticoagulant therapy, and followed up for 6 months. The change of limb swelling rate, lower limb venous patency rate, venous clinical severity score(VCSS), score of chronic venous insufficiency questionnaire(CIVIQ) and adverse reactions were analyzed to evaluate the curative effect and safety during 6 months of follow-up.Results:There was no significant difference in the change of limb swelling rate, lower limb venous patency rate, VCSS score, and CIVIQ score between the three groups(all P>0.05). The total hemorrhage events in warfarin group were significantly higher than the other two groups. Conclusions:The efficacy and safety of low-dose rivaroxaban (10 mg qd) in the treatment of lower extremity deep venous thrombosis after catheter directed thrombolysis were comparable to that of Rivaroxaban (20 mg qd).