ObjectiveTo study the influence of psychological intervention on anxiety and de-pression of patients before Mammotome minimally invasive biopsy system in resection of benign breast lump. Methods120 patients with breast lumps were divided into the experimental group and the control group with 60 cases in each group. The psychological intervention was used in the experimental group be-fore the surgery, including psychological cognition, psychological guidance and support, family support, etc,and the routine nursing care was given to the control group. SDS and SAS were used to evaluate the psy-chological state of the two groups before surgery using χ2 test. ResultsThe anxiety and depression score in the experimental group was significantly lower than that of the control group. ConclusionsThe psy-chological intervention before Mammotome minimally invasive biopsy system in resection of benign breast lump can effectively ameliorate the anxiety and depression of patients.

Objective:To develop specific anti-AML T cells in vitro,and to study their biological characteristics and functions.Methods:Peripheral blood or bone marrow mononuclear cells (MNCs) were isolated from 12 patients with AML,and co-cultured with cytokine combinations in 96 well plates to be induced into dendritic cells (DCs).Cell morphology was observed under an inverted microscope during the first week and immunophenotype was detected by flow cytometry at day 7.Cytokine combination was replaced with high dose IL-2 at day 7 to promote specific anti-AML T cells.T cell phenotype was detected after 4 to 5 weeks.Lactate dehydrogenase (LDH) release assay was used to determine T cell killing activity.Results:After being cultured with cytokine combinations,the typical dendritic appearance with delicate membrane projections was observed.CD80,CD86 and HLA-DR markers were significantly upregulated(P

Objective To investigate the protective effect of autophagy inducer rapamycin on acute kidney injury (AKI) induced by sepsis. Methods Twenty-four Sprague-Dawley (SD) male rats were randomly divided into sham group, caecal ligation and puncture (CLP) model group, and rapamycin treatment group (Rap treatment group), with 8 rats in each group. The septic AKI model was reproduced by CLP in rats, and rats in sham group were given appendix isolation without ligation and puncture. The rats in Rap treatment group were given 1.6 mg rapamycin by intraperitoneal injection immediately after model reproduction, and the rats in CLP model group were injected with an equal amount of normal saline. The rats in all groups were sacrificed after collecting peripheral blood specimen at 24 hours after model reproduction, and the levels of blood urea nitrogen (BUN) and serum creatinine (SCr) were determined. The pathomorphology change in renal tissue was observed under light microscope after periodic acid Schiff (PAS) staining. Real-time polymerase chain reaction (real-time PCR, RT-PCR) was used to determine the mRNA expressions of renal tubular autophagy related molecules Atg-5 and Beclin-1. Western Blot was used to detect the expressions of renal tubular autophagy associated protein microtubule labeled protein 1 light chain 3-Ⅱ (LC3-Ⅱ) and Beclin-1 as well as apoptosis protein cytochrome C (Cyt C), Bax and Bcl-2. TdT-mediated dUTP nick-end labeling (TUNEL) assay was used to determine the renal tubular epithelial cell apoptosis. Results Rapamycin could alleviate pathomorphology changes in rats with septic AKI, and decrease the levels of BUN and SCr. Compared with sham group, the expressions of Atg-5, Beclin-1 and LC3-Ⅱ in CLP model group were significantly increased [Atg-5 mRNA (2-ΔΔCt): 2.34±0.04 vs. 1.00±0.03, Beclin-1 mRNA (2-ΔΔCt): 1.40±0.02 vs. 1.00±0.03, LC3-Ⅱ protein (gray value): 0.82±0.03 vs. 0.45±0.04, Beclin-1 protein (gray value): 0.59±0.06 vs. 0.29±0.03, all P < 0.01]. Rapamycin could further up-regulate the expressions of Atg-5, Beclin-1, and LC3 Ⅱ [Atg-5 mRNA (2-ΔΔCt): 3.28±0.19 vs. 2.34±0.04, Beclin-1 mRNA (2-ΔΔCt): 2.38±0.08 vs. 1.40±0.02, LC3-Ⅱ protein (gray value): 1.11±0.07 vs. 0.82±0.03, Beclin-1 protein (gray value): 0.85±0.05 vs. 0.59±0.06, all P < 0.01]. Compared with sham group, the apoptotic cells in CLP model group were increased significantly [(34.49±10.45)% vs. (2.78±1.40)%, P < 0.01], Cyt C and Bax protein expressions were significantly up-regulated (gray value: 0.87±0.02 vs. 0.46±0.03, 1.20±0.06 vs. 0.46±0.01, both P < 0.01), and Bcl-2 expression was significantly down-regulated (gray value: 0.64±0.02 vs. 1.33±0.09, P < 0.01). Rapamycin could effectively inhibit cell apoptosis [(15.44±5.50)% vs. (34.49±10.45)%, P < 0.01] and the protein expressions of Cyt C and Bax (gray value: 0.72±0.03 vs. 0.87±0.02, 0.84±0.03 vs. 1.20±0.06, both P < 0.01), and up-regulate the protein expression of Bcl-2 (gray value: 0.77±0.04 vs. 0.64±0.02, P < 0.01). Conclusion The protective effect of rapamycin on renal tissue of rat with AKI induced by sepsis was depended on cell apoptosis inhibition through inducing and promoting cell autophagy.

Objective Focal nodular hyperplasia(FNH) is composed of multiple hyperplastic liver cell nodules,but its pathogenesis has not been elucidated. Foci (FAH) or nodules of altered hepatocytes (NAH) are precursors of hepatocellular adenoma (HCA) and carcinoma.This study aimed at identifying FAH and NAH from FNH and evaluating their role in FNH development.Methods 6 FNH lesions from 5 patients and 10 HCA from 9 patients were examined histologically,and expression levels of CD_(34) cytokeratin 19(CKl9) and Ki-67 antigen were demonstrated immunohistochemicailly.Proliferative activity was evaluated by Ki-67 antigen-labeling indices(Ki-67 LI).Results Multiple FAH and NAH were identified in all of the 6 FNH lesions. Whiie micmvasculatures were demonstrated by CD_(34) immunoreactivity in both HCA and FNH,their density and distribution were different in these two lesions,being diffuse in HCA and focal or nodular,mainly within NAH.CKl9 expression Was found in FNH,localized in ductal and ductular cells,but not within NAH and HCA.Average Ki.67 LI of 73 NAH(2.8%) was shown to be higher than that of the whole FNH lesions (0.6%),and had no statistieal difference comparable to that of HCA(1.8%).Conclusion Muhiple NAH are present in all classical FNH lesions.Unlike the surrounding parenchyma,NAH lesions are more proliferative and equipped with CD_(34)-positive microvasculatures as in HCA.

ObjectiveStudy the ADC value and the maximal diameter and their changes of breast cancer before and after neoadjuvant chemotherapy,to determine the relationship with different expression level of Ki-67.Methods Forty eight patients with breast cancer confirmed by biopsy underwent MR DWI and enhanced scan before and after 4 cyclesneoadjuvant chemotherapy.ReviewtheMRimages retrospectively.The ADC value and the maximum diameter( D)of the cancer foci were measured before and after chemotherapy,and the rate of their changes △ADC％ and △D％ were calculated.Using different Ki-67 index level,all the foci were divided into three groups:group A with Ki-67 ＜ 20％,group B with Ki-67 between 20％ and 60％,and group C with Ki-67 ＞ 60％.Using nonparameter test to compare the ADC values,△ADC％,D and △D％ of the three groups before and after chemotherapy,determine whether there were differences.ResultsBefore chemotherapy,the ADC value of group A ( n = 15 ) was 1.1 ×10-3 mm2/s[ (0.9 × 10-3—1.2 × 10-3) mm2/s],which was higher than that of group B[n = 8,0.9 ×10-3 mm2/s(0.9 × 10-3-1.0 × 10-3) mm2/s] and C [n =25,0.9 × 10-3 mm2/s(0.7 × 10-3—1.2 ×10-3) mm2/s],and the difference was statistically significant (P ＜0.05 ) ; while the ADC value of group C after chemotherapy was 1.3 × 10 -3 mm2/s[ (0.2 × 10 -3—1.4 × 10 -3 ) mm2/s],which was higher than that of group A [1.1 × 10-3 mm2/s,(1.0 × 10-3—1.2 × 10-3) mm2/s] and B[1.1 × 10-3 mm2/s,( 1.0 × 10-3-1.1 × 10 -3 ) mm2/s],and the differences were statistically significance ( P ＜ 0.01 ) ; the ADC change rate( △ADC％ ) of group C was 45.5％ ( - 12.0％ —78.6％ ),which was greater than group A [45.5％ ( - 12.0％—78.6％ ) ] and B [ 45.5％ ( - 12.0％—78.6％ ) ],the difference was significant (P ＜ 0.01 ).The maximum diameters of group A were 2.2 cm (2.0—2.4 cm)and 1.0 cm(0.0—1.4 cm)before and after chemotherapy,lower than those of group B [ 3.7 cm ( 3.6—3.9 cm ) before NAC,2.9 cm (0.0-3.1 em) after NAC] and group C[3.4 cm(2.7—4.2 cm) before NAC,1.9 cm(0.0—2.2 cm) after NAC ],and the differences were statistically significant ( P ＜ 0.05 ) ; the change rate of the maximum diameter in group B was 21.6％ ( - 15.2％—27.5％ ),which was less than group A [52.7％ ( -23.6％—72.1％)] (P＜0.01) and C [51.2％ ( -10.3％—92.6％)] (P ＜0.05),and the difference was statistically significant.Conclusion The ADC values and the maximal diameter of breast cancer differed with different expression levels of Ki-67 index before and after neoadjuvant chemotherapy,and the response to neoadjuvant chemotherapy of which varied as well.

Objective To describe the development of nodules of altered hepatocytes (NAH) in chronic hepatitis B and to reveal progression of the nodules to hepatocellular carcinoma (HCC). Methods HCC, NAH and ordinary regenerative nodules (ORN) were identified and compared histologically. Expression levels of hepatitis B virus (HBV) antigens, mitoactivity and p53 accumulation in these lesions were evaluated by immunohistochemistry. Results Multiple foci of altered hepatocytes (FAH) and NAH were identified in the liver parenchyma surrounding HCC in all of the samples examined. Sequential architectural and cellular changes were observed during the progression of FAH to NAH and HCC. Expression levels of HBV surface and core antigens were found to be significantly decreased in ORN, NAH and HCC, with their positive rates being 70 % (35/50), 50 % (25/50), 10 % (5/50) and 60 % (30/50), 40 % (20/50), 6 % (3/50), respectively (P ＜0.05). Ki-67-1abelling indices were determined to be (0.58±0.49) %, (2.46±1.05) % and (40.36±26.27) %in these lesions, respectively (P ＜0.05). Nuclear p53 accumulation was found only in HCC. Its occurrence was associated to a high histological grade, with its frequencies being 13 % (1/8), 41% (11/27) and 73 % (11/15)in grade 1, 2 and 3 lesions, respectively. Conclusion NAH lesions, identified by their morphologic features and mitoactivity elevation, are detectable in resected liver samples with chronic hepatitis B and cirrhosis. They represent a common HCC precursor and can be used as a surrogate marker for the surveillance of high-risk individuals.

Objective To Compare different methods of quantitative breast density measurement.Methods The study included sixty patients who underwent both mammography and breast MRI. The breast density was computed automatically on digital mammograms with R2 workstation. Two experienced radiologists read the mammograms and assessed the breast density with Wolfe and ACR classification respectively. Fuzzy C-means clustering algorithm (FCM) was used to assess breast density on MRI. Each assessment method was repeated after 2 weeks. Spearman and Pearson correlations of inter- and intrareader and intermodality were computed for density estimates. Results Inter- and intrareader correlation of Wolfe classification were 0. 74 and 0. 65, and they were 0. 74 and 0. 82 for ACR classification respectively.Correlation between Wolfe and ACR classification was 0. 77. High interreader correlation of 0. 98 and intrareader correlation of 0. 96 was observed with MR FCM measurement. And the correlation between digital mammograms and MRI was high in the assessment of breast density (r = 0. 81, P ＜ 0. 01). Conclusion High correlation of breast density estimates on digital mammograms and MRI FCM suggested the former could be used as a simple and accurate method.

Objective To investigate the clinical value of tumor's longest diameter and volume in assessing pathologic response in locally advanced breast cancer treated with neoadjuvant chemotherapy(NAC).Methods A prospective study was undertaken in women undergoing NAC for locally advanced breast cancer in order to determine the ability of quantitative MRI to assess the final pathologic response. 36 cases with pathologically confirmed locally advanced breast cancer who had been undergone four courses of NAC underwent preoperative breast MRI three times during the NAC. Pathologic response was assessed according Miller & Payne grading system, of which grade 4 and 5 defined as major histological response (MHR), and grade 1 to 3 as non-major histological response (NMHR). The tumor's longest diameters and volumes in MHR were compared with those in NMHR by Mann-Whitney U test before, after the second and fourth cycle of NAC. Concordance correlation coefficient (CCC) were assessed to evaluate the agreement between the two method. Receiver operating characteristic curve (ROC) analysis was carried out to assess the clinical value of tumor size and the change rate.Results Before,after the second and the fourth cycle of NAC, the difference of tumor's longest diameters and their first change rate between MHR [(2.75±1.16) cm,(2.19±1.07) cm ,(1.58±0.75) cm and (21.70±15.09)%]respectively,and NMHR [(2.71±1.10) cm,(2.33±0.90) cm,(2.01±0.94) cm and (11.68±10.27)%] respectively were not significant(P>0.05). The second change rate of tumor's longest diameter in MHR [(39.00±15.38)% ] was significantly higher than that in NMHR[ (25.83±21.77)% ](P=0.04). Before, after the second and the fourth cycly of NAC, the differences of tumor volumes and their first change rate between MHR [ median 14.00 cm~3 ( range 2.96～83.41 cm~3 ) , median 7.31 cm~3 (range 0.05～55.35 cm~3), median 2.69 cm~3 (range 0～33.40 cm~3 ) , median 48.65% (range 33.64%～98.48%) ] and NMHR [median 4.25 cm~3 (range 4.78～106.55 cm~3), median 10.53 cm~3 (range 1.72～42.85 cm~3), median 7.56 cm~3 (range 0.68～156.58 cm~3), median 52.04% (range-35.79%～78.31%) ] were not significant. The second changing rate of tumor's volume in MHR [median 85.37% (ranged 27.52%～100%)] was significantly higher than that in NMHR [median 68.80% (ranged -289.60%～94.24%)](P=0.01). CCC was computed before and (0.82), after the second cycle (0.67) and after the fourth cycle (0.55), in all examinations pooled together (0.78).The second change rates of tumor's longest diameter and volume were equal to predict the final pathologic response, and the area under curve were 0.75 and 0.80, respectively (P=0.61). Conclusion The agreement between the tumor's longest diameters and tumor's volumes is good in all in breast carcinoma. The assessment efficacy of the change rate of tumor's longest diameter and that of volume were low.

Objective To investigate the clinical value of the type and the steepest slope of tumor's time-intensity curve (TIC) in assessing the pathologic response of locally advanced breast cancer treated with neoadjuvant chemotherapy (NAC). Methods Thirty-six patients with pathologically confirmed locally advanced breast cancer who finished four courses of neoadjuvant chemotherapy underwent preoperative breast MRI three times during the NAC. Pathologic response was assessed according Miller-Payne grading system, grade 4 and 5 were defined as major histological response ( MHR, n = 16) group, and grade 1 to 3 as nonmajor histological response( NMHR,n = 20)group. The type and the steepest slope of tumor's TIC were compared between two groups before NAC, after the second cycle and after the fourth cycle of NAC. ROC analysis was carried out to assess the clinical value of the TIC parameters. Results After the second cycle of NAC, the steepest slope of TIC and its first change rate were different between the MHR group [ ( 1.93 ±0.88) %/s, median 35.6%] and NMHR group [(2.73 ± 1.22) %/s, median - 11.4%] (P =0.045 and 0. 01,t=1. 09,Z= -3.64). After the fourth cycle, the proportion of type Ⅰ in MHR group (62.5% ,10/16) was significantly higher than that in NMHR group (10.0%, 2/20, P = 0.01, Z=-2. 02), and the proportion of type Ⅲ in MHR group (6. 2% ,1/16)was significantly lower than that in NMHR group (60. 0% ,12/20,P =0. 01 ,Z = -1.48). The steepest slope and its second change rate were different between the MHR group [ ( 1.33 ± 0. 52) %/s, median 56. 8% ] and NMHR group [ (2. 33 ±0. 94) %/s, median 15. 8% ] ( P ＜ 0. 01, t = 1.82, Z = - 3. 58 ). After the second cycle, the area under curve of the steepest slope of TIC and its first change rate were 0. 70 ( P = 0. 04 ), 0. 80 ( P = 0. 01 ),respectively. After the fourth cycle, the area under curve of the type Ⅰ, the type Ⅰ + Ⅱ, the steepest slope and its second change were 0. 78 ( P = 0. 03 ), 0. 69 ( P = 0. 06), 0. 82 ( P = 0. 01 ), 0. 92 ( P = 0. 01 ),respectively. Conclusion The steepest slope of TIC and its first change rate could assess the NAC response after the second cycle, and the type Ⅰ, the steepest slope and its second change could assess the NAC response after the fourth cycle.

Objective To study the value of the semiquantitative-parameter analysis of wash out index of time-intensity curve (Swash-out) in evaluating the therapeutic effect of neoadjuvant chemotherapy for locally advanced breast cancer (LABC).Methods Fifty-nine women with LABC underwent dynamic contrast enhancedt MRI examination before chemotherapy,after the 2nd cycle and the 4th cycle of chemotherapy.All patients were divided into major histological response group (MHR) and non-major histological response group (NMHR) according to the final pathologic response.Swash-out and the variancetrends of Swash-out before NAC,after the 2nd cycle of NAC and after the 4th cycle of NAC were compared in each group and between the two groups.According to the gold standard of Miller & Payne criterion,Receiver operating characteristic curve (ROC) analysis was performed to evaluate the predicting effect of Swash-out for NAC response,and to compare it with Semi-quantitative TIC curve indicators Smax (steepest slope) and PPE (peak percent enhancement).Results Fifty-nine patients of LABC patients were divided into a MHR group of 34 patients and a NMHR group of 25 patients.Swash before NAC of MHR group was-16.99 (-56.72-41.20),Swash-out after the 2nd cycle of NAC was 5.66(-69.45-53.08),Swash-out after 4th cycle of NAC was 15.95 (-7.80-54.23).Swash-out before NAC of NMHR group was-23.08 (-64.24-34.39),Swash-out after the 2nd cycle of NAC of NMHR group was-23.01 (-52.72-28.70),Swash-out after 4th cycle of NAC of NMHR group was-11.45 (-50.49-50.93).Swash-out variance rate of MHR group after the 2nd and the 4th cycle of NAC were-1.18 (-31.32-60.86) and 1.50 (-86.27-3.61),respectively.Swash-out variance rate of NMHR group after the 2nd and the 4th cycle of NAC were-0.28(-3.24-9.46) and 0.27 (-5.34-3.11),respectively.Swash-out was not significantly different between the two groups before NAC (Z =-0.97,P ＞0.05).Swash-out and Swash-out variance rate of MHR group after the 2nd cycle of NAC were significant higher than that of NMHR group (Z =-3.97 and-3.02,P ＜0.01).Swash-out and Swash-out variance rate of MHR group after the 4th cycle of NAC were significant higher than that of NMHR group (Z =-3.96 and-3.16,P ＜ 0.01).Area under curve (Az) after the 2nd and the 4th cycle of NAC were 0.805 and 0.804,respectively,and no significant difference was found between them (Z =0.019,P ＞0.05).Diagnostic cut-off points were-8.670 for the 2nd cycle of NAC and 4.105 for the 4th cycle of NAC.Diagnostic sensitivity was 79.42％,specificity was 76.00％ and Youden index was 0.554,for after the 2nd and the 4th cycle of NAC.Conclusion Swash-out of TIC curve before NAC cannot predict the response of NAC,Swash-out of TIC curve after the 2nd cycle of NAC and after the 4th cycle of NAC are efficient in predicting the response of NAC.