Objective To explore a better medication by analyzing retrospectively 179 cases with confirmed auricle pseudocyst.Methods A comparative study was carried out for the clinical effects of injecting triamcinolone acetonide in cavity with that of washing the cyst using dexamethasone and fixing it with gypsum.Results There was significant difference between the two groups(P

Objective To compare the diagnostic performances of strain elastography (SE) and shear-wave elastography (SWE) in differentiating benign and malignant solid breast lesions. Methods From January 2015 to December 2015, 150 patients with 155 lesions were examined with SE and SWE respectively in the First Affiliated Hospital with Nanjing Medical University. Elasticity scores on a improved 5-point scale,strain ratio (SR), maximum elasticity (Emax), mean elasticity (Emean), standard deviation of the elasticity (Esd) and the lesion-to-fat elasticity ratio (Eratio) were assessed. The receiver operating characteristic (ROC) curve of SE and SWE parameters were plotted to assess the value in distinguishing benign and malignant breast lesions. The results were compared using the area under the ROC curve (AUC). The accuracy of the parameters with the largest AUC were compared between SE and SWE by McNemar test in different breast imaging reporting and data system (BI-RADS) categories. Results The AUC of elasticity scores, SR, Emax,Emean, Esd and Eratio were 0.823, 0.810, 0.877, 0.835, 0.881 and 0.853, respectively. The SE and SWE parameter with the largest AUC were elasticity scores and Esd respectively. The accuracy of Esd was higher than that of elasticity scores(86.3% vs 64.7%)in 4A lesions (2=4.639, P < 0.05). There were no significant differences in accuracy in other BI-RADS categories. Conclusions Both SE and SWE were helpful for the differentiation of benign and malignant solid breast lesions, and the diagnostic performance of SE and SWE was similar. The optimization of elastography can be achieved by combination with BI-RADS.

Objective:To analyze one case of diabetes allergic to insulin preparations and investigate the role of clinical pharmacist in the treatment. Methods:Different insulin preparations were tried out after the patient was allergic to one kind of insulin preparation. However, the allergic symptoms were not improved significantly. Clinical pharmacist recommended to use glargine combined with oral hypoglycemic drugs instead of insulin containing protamine for the patient. Results:The allergic symptoms of the patient were improved significantly after the drug adjustment in the hypoglycemic program by clinical pharmacist. The blood glucose was controlled and aller-gic symptoms didn't show again during the hospitalization. Conclusion:Clinical pharmacist can participate in the treatment of diabetes allergic to insulin preparations through identifying allergens accurately and improving individual hypoglycemic program using pharmaco-logical knowledge. It is important to improve the clinical diagnosis and treatment, and ensure and promote the safety of medical treat-ment and drug use.

Objective To evaluate the factors influencing prognosis and to explore the pathological mechanism in which herpes simplex virus encephalitis(HSE) was one of the severe types of acute viral encephalitis in children and had poor prognosis.Methods Twenty-one children with HSE were diagnosed by the clinical syndrome of focal encephalitis and HSV DNA-PCR positive in cerebrospinal fluid(CSF) from Jan.2012 to Oct.2013,among whom,19 patients were treated with intravenous Acyclovir,30 mg/(kg · d) 48 hours after onset and were followed up for 6 to 24 months.Clinical data were collected including Glasgow Coma Score,the brain magnetic resonance imaging(MRI),and electroencephalography(EEG).All MRI examinations including plain scan and contrast enhancement were carried out at the beginning of admission and 1 month after the onset of symptoms.The clinical outcomes were divided into two levels accoming to the severity of the neurological deficit,then the data were analyzed by using Logistic regression and Fisher's exact probability method.The OR value was calculated.Results Eighteen children survived,of whom 5 cases had no neurological deficit(27.8％),3 cases were left with mild impairment(16.7％),and the above 8 cases were thought to have better outcome.Six cases had moderate impairment (33.3％) and 4 cases had severe impairment(22.2％) and 1 child died,and these 11 cases were thought to have worse outcome.Patients aged between 1 month and 10 years,average (2.03 ± 2.23) years old.The mean GCS score was (9.68 ± 2.65) scores,the GCS of the patients were more than 7except for one death child with 3 scores.The multiple factor analysis showed that EEG,age,GCS and the range and character in MRI were significantly correlative to the prognosis(P ＜ 0.05).The single factor analysis illustrated that age 1-4 years old(OR =30,95％ CI 2.066-366.510,P =0.002),GCS ≤ 10 scores(OR =27.518,95％ C1 2.066-366.510,P =0.004)and the wide necrosis existence involving diffuse white matter or deep nuclei of MRI findings (OR =12,95 ％ CI 1.294-111.323,P =0.017) indicated the worse outcome.Conclusions Age,GCS score,nature and damage degree of MRI lesions are the main important factors affecting the prognosis of children's HSE.HSE in children is apt to involve the cortex such as frontal lobe,parietal lobe even diffuse white matter or deep nuclei,which indicates the poor prognosis.

Objective: To explore the predictive value of high-sensitivity C-reactive protein (hs-CRP) levels in patients with persistent atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA). Methods: A total of 77 patients of persistent AF as the first diagnosis with initial RFCA in our hospital were studied. The patients were divided into 2 groups: Recurrent group, n=27 and Non recurrent group, n=50. Basic clinical conditions were studied by Cox model analysis to screen the risk factors for AF recurrence, receiver operating characteristic (ROC) curve was conducted to assess the predictive value of hs-CRP level on AF recurrence. Results: AF recurrence was related tothe age (HR=1.126, 95% CI 1.044-1.215, P=0.002), body mass index (HR=1.297, 95% CI 1.077-1.563, P=0.006), hypertension at stage II (HR=4.142, 95% CI 1.047-16.390, P=0.043), hypertension at stage III (HR=8.595, 95%CI 1.913-38.610, P=0.005), left atrial size (HR=1.438, 95% CI 1.212-1.707, P=0.000) and hs-CRP (HR=2.026, 95% CI 1.010-4.061,P=0.047). The area under ROC curve of hs-CRP level was 0.693,P=0.005 with the cut-off point at 0.355 mg/dl. Conclusion: Persistent AF recurrence after RFCA was related to pre-operative inflammatory status; actively control pre-operative condition may reduceAF recurrence, improve prognosis and decrease adverse cardiovascular event in relevant patients.

Objective To explore the relationship between activation-induced cytidine deaminase (AID) expression and melanoma invasion, metastasis and prognosis, and to evaluate the clinical significance of AID. Methods An immunohistochemical study was conducted to detect the expression of AID in paraffin-embedded tissue sections from 80 cases of melanoma and 23 cases of pigmented nevus. The relationship between the expression of AID and clinicopathological and biological features of melanoma was analyzed. Results The expression rate of AID was significantly higher in melanoma than in pigmented nevus tissue specimens(53.75%(43/80)vs. 13.04%(3/23), P<0.05). AID expression was closely correlated with lymphatic metastasis, Clark grade, depth of invasion and prognosis of melanoma (all P<0.05), but was of no significant difference among patients of different age, gender or nationalities(all P > 0.05). Of 19 melanoma specimens with BRAF mutations, 17 expressed AID, including all the 15 melanoma specimens with the BRAFV600E mutation. Conclusions AID may induce BRAF mutations in melanoma, participate in melanoma invasion and metastasis, and be correlated with melanoma prognosis.

Objective: To investigate the differences of biochemical markers between the patients with pulmonary hypertension related to left heart disease (PH-LHD) and LHD; to explore the sensitive bio markers which may predict PH in LHD patients. Methods: A total of 355 LHD patients admitted to our hospital from 2014-01 to 2015-05 were enrolled. According to 2009 ESC/ERS guidelines, PH was deifned by pulmonary artery systolic pressure (PASP)>50 mmHg and patients were divided into 2 groups: LHD group,n=224 and PH-LHD group,n=131. The basic information with blood levels of biomarkers was recorded and their accuracy for predicting PH was analyzed. Results: The pathogenesis of LHD included 184 (51.83%) patients of coronary heart disease, 90 (25.35%) of dilated cardiomyopathy and 81 (22.81%) of cardiac valve heart disease. Compared with LHD group, PH-LHD group had increased ratio of NYHA III and IV degree (89.31% vs 45.54%), decreased LVEF [42.0 (33.0, 59.0) % vs 60.0 (42.0, 65.0) %], all P<0.001; PH-LHD group presented elevated blood levels of BNP, bilirubin, red cell distribution width (RDW), uric acid and cystatin C, while reduced lipoprotein (HDL), allP<0.001. PASP was positively related to biomarkers as BNP, bilirubin, RDW, uric acid and cystatin C, while negatively related to HDL. With the combination of BNP, direct bilirubin and RDW, the predictive value for PH-LHD under ROC curve was 0.828 with the sensitivity at 0.813, speciifcity at 0.708. Conclusion: Blood levels of biochemical markers were statistically different between the patients of PH-LHD and LHD; the combination of BNP, direct bilirubin and RDW showed the higher accuracy for predicting PH occurrence in LHD patients.

Objective To investigate the diagnostic value of digital breast tomosynthesis (DBT) plus full-field digital mammography (FFDM) in benign and malignant breast disease.Methods The prospective study enrolled 46 consenting women with a clinical suspicious of breast lesion confirmed by pathology. All the patients underwent DBT, FFDM and dedicated breast magnetic resonance image (DB-MRI) examinations before surgery or biopsy. To observe the manifestation of breast disease in different examinations according to breast imaging reporting and data system (BI-RADS), and to evaluate the visibility grade of disease between DBT plus FFDM and FFDM alone. Using receiving operating characteristic(ROC) and Z test to analysis the diagnostic efficiency of three examinations.Results Forty-six cases included 14 benign cases and 32 malignant cases. Compared with FFDM, 35 cases showed increased visibility in DBT plus FFDM, that the malignant lesion manifested mass with speculated and architectural distortion(23/27) and the benign lesion manifested mass with halo sign(6/8). Eleven cases didn't show increase visibility in both DBT plus FFDM and FFDM alone. The ration of BI-RADS 0 in FFDM was 23.9%(11/46), meanwhile in other two examination were 0. The ration of BI-RADS 3 in DBT plus FFDM was the lowest(6.5%, 3/46). When the lesion in DBT plus FFDM showed mass or speculated, in MRI showed similar morphology with mass or mass-like enhancement. According pathology as the gold standard, excluded 11 cases with BI-RADS 0 in FFDM, there was significant statistical difference between DBT plus FFDM and FFDM alone in 35 cases (Z=2.132, P=0.033) to differentiate benign and malignant breast disease, the area of ROC curve were respectively 0.955, 0.878. There is no statistical difference between DBT plus FFDM and MRI in 46 cases (Z=0.502, P=0.616), the area of ROC curve were respectively 0.887, 0.908.Conclusion DBT combined with FFDM can improve both detection of breast lesion and diagnostic efficiency, while the performance value between DBT and MRI are equal.

AIM:To study the expression of Jagged 2/Notch3 signaling molecules in pulmonary vascular wall of pulmonary hypertensive rats induced by monocrotaline .METHODS: SD rats were randomly divided into normal control group (C group,n=15), solvent control group (S group,n=15) and monocrotaline model groups (M group,n=15).The model of pulmonary hypertension was established by a single subcutaneous injection of monocrotaline (50 mg/kg).The rats in S group were given a single subcutaneous injection of the same dose of solvent .After 4 weeks, the pulmonary vascular remodeling was assessed by HE staining , and the mean pulmonary artery pressure ( mPAP) and right ventricular systolic pressure (RVSP) were determined by right heart catheterization .The expression of Jagged2/Notch3 /Hes5 molecules in the pulmonary vascular wall was detected by immunohistochemical method and real -time PCR.RESULTS:Compared with S group and C group , the percentage of medial wall thickness of smaller arteries in model group increased significantly (P<0.01).The levels of mPAP and RVSP in M group were significantly higher than those in S group and C groups (P<0.01).The results of real-time PCR showed that the expression of Jagged 2, Notch3 and Hes5 was significantly increased in M group compared with S group and C group .The data from immunohistochemical detection indicated that Jagged 2 mainly expressed in the intima of small lung artery , Notch3 and Hes5 mainly expressed in the medial smooth muscle cells .Com-pared with S group and C group , the expression of Jagged 2 and Notch3 was significantly increased in the lung small arteries of M group.CONCLUSION:The activation of Jagged2/Notch3 signaling pathway might play an important role in the for-mation of pulmonary hypertension .

Objective: To investigate the multi-imaging diagnostic values, especially MSCT technology in patients with congenital aortic diverticulum with its clinical application. Methods: The MSCT ifndings in 12 patients with congenital aortic diverticulum were retrospectively analyzed. Results: There were 9 patients with right aortic arch and 1 with left aortic arch, all of them having coexisted aberrant subclavian artery which initially dilated like aneurysm by diverticulum changing (Kommerell diverticulum), and there was 1 patient with incomplete double aortic arch with atresia of left arch combining retro-esophageal aortic diverticulum (RAD) and 1 patient with ducts diverticulum. Echocardiogram only made the suggestive diagnosis of speeding up blood lfow or right aortic arch in 4 patients. While MSCT accurately displayed the diverticulum for the location, morphology and with or without other complications. The post-eroanterior chest radiograph indicated “double aortic node” as the special sign in 8 patients. The echocardiogram, X-ray and MSCT for correctly diagnosing the aortic diverticulum were as 0, 72.7% and 100% respectively. Conclusion: MSCT is a rather ideal non-invasive diagnosing method for aortic diverticulum, meanwhile X-ray could also make suggestive diagnosis; if MSCT and X-ray joint with echocardiogram examination may provide the effective supplement for valve structure and hemodynamics condition in relevant patients.