Objective To evaluate special diagnosis and treatment of occult breast cancer. MethodsDiagnostic means used included breast roentgenography,selective mammary ductography, fine needle aspiration and excision biopsy in 28 cases. ResultsBreast roentgenography detected 4 cases ( 7/16), selective mammary ductography identified 4 cases(4/6). The definite diagnosis rate by lump biopsy and immunohistochemistry was 10 cases (10/13). Postoperative follow-up was abtained in 18 cases,with 5 dying of recurrence or distant metastases. Among them 4 patients underwent only axillary node excision. Conclusion Nipple discharge,localized thickening the gland are very important clue to the diagnosis of occult breast cancer.Lump biopsy and immunohistochemistry is a mainstay for the final establishment of the diagnosis of breast cancer. Radical or modified radical mastectomy with adjuvant radiotherapy and chemotherapy is a suitable treatment modality for occult breast cancer.

Objective To analyze the diagnosis,treatment and prognosis of small cell carcinoma of bladder (SCCB) in order to improve the understanding of it.Methods The pathological and clinical data of 5 cases of SCCB were retrospectively analyzed.All patients were male,aged 50 to 78 years (mean age,64 years).Clinical manifestations of 4 cases were gross hematuria,the other case was found by health examination.Ultrasonography results of 3 cases were medium echo tumors,the other 2 cases were hypoecho tumors.The diameter of the tumor was 2.1 to 4.0 cm (mean,3.0 cm).There were 3 patients accepted CT scan.One of them was found of hydronephrosis and multiple pelvic lymph nodes.All patients accepted diagnostic TURBT.Three of them accepted postoperative chemotherapy (1 cycle) without other surgery.Two patients accepted radical cystectomy with postoperative chemotherapy (3 cycles) after bladder tumor biopsy.Results Pathological findings showed that tumor cells were small,round and sheet in arrangement.These hyperchromatic nuclei showed limited cytoplasm with lack of nesting character.Neuron specific enolase,chromogranin A and synaptophysin were positive in immunohistochemistry.The final diagnosis was SCCB'.Two of the three patients who accepted TURBT with postoperative chemotherapy died 7 and 8 months postoperatively,the other one was alive for 32 months.Another two patients who accepted radical cystectomy with postoperative chemotherapy were alive for 16 and 26 months.Conclusions SCCB is a rare tumor which has high malignancy and poor prognosis.Radical cystectomy in combination with postoperative chemotherapy is the main treatment.Retained bladder surgery with chemotherapy is an alternative choice.

0.1 ?mol?L-1), inducing differentiation through enhancement of melanogenesis and increase of the activity of tyrosinase at lower doses(

Objective To study the guiding role of ultrasonography to the operation of spontaneous constriction of radial nerve.Methods Six patients with spontaneous constriction of radial nerve were checked by ultrasound before operation to identify the number,position and morphological change of the constriction lesions of the radial nerve.The result was compared with the operation result.Results According to the ultrasonography results,2 to 3 constriction lesions were found on the radial nerve of all the 6 patients.The ultrasonography description of the number,position and morphological change of the lesions was consistent with the operation result.After the operation,the radial nerve function of all the patients got recovered.Conclusions Ultrasonography examination before operation can identify the number,position and morphological change of the constriction lesions of the radial nerve,which has great value when planning the operation.

Objective To investigate the effect of noninvasive positive pressure ventilation treatment on patients with acute left heart failure and hyoxemia.Methods Sixty-two patients with acute left heart failure and hyoxemia were divided into control group (31 cases) and treatment group (31 cases).All patients were treated with a conventional therapy plan and patients in treatment were received noninvasive positive pressure ventilation beside conventional therapy.Blood gas analysis,plasma B-type natriuretic peptide (BNP) and clinical manifestation before and after treatment were monitored.Results The time of clinical manifestation al0leviation in treatment group was (33.7 ±7.9) min,shorter than that of control group ((55.9 ± 12.1) min,t =8.554,P ＜0.01).Compared with pre-treatment,heart rate (HR),respiratory rate(RR),mean arterial pressure(MAP),pH,oxygen saturation of blood (SaO2),arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide(PaCO2) and BNP in treatment group were improved significantly(HR:(133.89 ± 5.45) beat/ min vs.(87.27 ± 5.74) beat/min,t =32.794,P ＜ 0.01 ; RR:(34.25 ± 5.67) beat/min vs.(20.15 ± 2.54) beat/min,t =12.636,P ＜ 0.01 ; MAP:(104.52 ± 7.25) mmHg vs.(76.57 ± 3.76) mmHg,t =19.055,P ＜0.01; pH:(7.29±0.06) vs.(7.40 ±0.06),t=7.218,P＜0.01;SaO2:(81.52 ±5.01)％ vs.(97.16±1.27) ％,t =16.848,P ＜ 0.01 ; PaO2:(55.30 ± 7.14) mmHg vs.(92.80 ± 6.24) mmHg,t =22.019,P ＜0.01;PaCO2:(46.23 ±10.30) mmHg vs.(40.56 ±5.19) mmHg,t =2.737,P＜0.05;BNP:(831.59 ±292.65) ng/L vs.(265.52 ±65.39) ng/L,t =10.511,P ＜0.01).And after treatment,HR,RR,MAP,SaO2,PaO2,BNP in control group were improved compared with that before treatment (HR:(132.13 ± 5.31) beat/min vs.(92.15 ± 4.28) beat/min,t =32.638,P ＜ 0.01 ;RR:(34.96 ± 4.78) beat/min vs.(23.91 ± 3.27) beat/min,t=l0.634,P＜0.01;MAP:(102.56 ±7.14) mmHg vs.(82.83±3.52) mmHg,t =13.800,P＜0.01;SaO2:(82.15 ± 5.24) ％ vs.(93.16 ± 2.59) ％,t =10.488,P ＜ 0.01 ; PaO2:(54.56 ± 6.27) mmHg vs.(75.19 ±3.52) mmHg,t =15.974,P ＜0.01 ;BNP:(823.15 ±277.26) ng/L vs.(371.15 ±87.55) ng/L,t =8.656,P ＜0.01).Statistical differences of pH and PaCO2 were not found in the control group before and after treatment(pH:7.32 ± 0.05,t =1.426,P =0.159 ;PaCO2:(43.78 ± 6.74) mmHg,t =0.253,P =0.801).HR,RR,MAP,pH,SaO2,PaO2,PaCO2 and BNP in treatment group were more significantly improved than that of control group(t =3.795,5.056,6.767,5.703,7.721,13.686,2.107 respectively,P ＜ 0.01or P ＜ 0.05).Conclusion The therapy plan of noninvasive positive pressure ventilation on patients with acute left heart failure and hyoxemia can improve cardiac function and oxygenation quickly,and decrease the plasma BNP level.

This study is to establish a simple and practical co-culture method of cortical neurons and astrocytes of rats. The cortex of the new-born SD rats was digested by 0.125% pancreatic enzyme, and the differential adherence was applied to obtain the mixed cell suspension of neurons and astrocytes. A low concentration of cytarabine was used to inhibit the astrocytes in a moderate way to get neuronal and astrocyte co-culture. The morphological characteristics of the cells in different times were observed under the inverted microscope. The cells began to adhere the wall 2 h after the inoculation. Neurons and astrocytes grew in a good condition under the inverted microscope 9 days after the inoculation. The results of the immunofluorescence staining and Rosenfeld's staining indicated that the co-culture of neurons and astrocytes was successful and the ratio of neurons and astrocytes was close to 1:1. A new neurons and astrocytes co-culture method, which is simple and convenient, was successfully established. It will be an efficient method for the related researches about neuronal and astrocyte co-culture in vitro.

Objective:To explore the calvarial critical size defect (CSD)in rats with type 2 diabetes mellitus(T2DM).Methods:T2DM model of SD rats(weighted 300-320 g)was induced by high fat and high sugar diet and low dose intraperitoneal streptozotocin (STZ)injection.The rats with T2DMand the normal controls were divided into 4 groups(n=3)respectively.Defects with the diame-ter(mm)of 2,3,4 and 5 were made on the central calvaria of each rat.General observation,X-ray examination and histological study were performed 8 weeks postoperatively.Results:In the T2DM group,only the defects of 2 mm diameter were healed completely,X-ray resistance and new bone formation were observed;the defects of 3,4 and 5 mm diameter were unhealed,X-ray transmission was observed and newly formed bone was insufficient.In the control group,the defects of 2,3 and 4 mm diameter were healed completely, X-ray resistance and new bone formation were observed;the defects of 5 mm diameter were unhealed,X-ray transmission was ob-served,newly formed bone was insufficient.Conclusion:The calvarial CSD of T2DM rat model can be defined as the defect with the diameter of 3 mm.

OBJECTIVE To study the toxicity of zinc oxide nanoparticles (ZnO-NPs) on murine macrophage Ana-1 cells and the mechanism.METHODS Ana-1 cells were incubated with ZnO-NP (2.5-160 mg· L-1).Cell viability was investigated by MTT assay.The integrity of cell membrane was investigated by acridine orange-ethidium bromide (AO-EB) staining.The intracellular uptake of ZnO-NP and the percentage of sub-G1 of Ana-1 cells were detected by flow cytometry.Zinc ions were determined by fluorescent probe.The change of cell viability was studied after chelating zinc ions with ethylene diamine tetraacetic acid (EDTA).RESULTS ZnO-NP 2.5,5,10 and 20 mg· L-1 decreased cell viability of Ana-1 cells (r=0.905,P＜0.05) in a concentration-dependent manner.The cell viability was decreased to 27.9％ after exposure to ZnO-NP 20 mg· L-1.Intracellular uptake of ZnO-NP was increased after Ana-1 cell incubated with ZnO-NP at concentrations ranging from 40 to 160 mg· L-1 (P＜0.05).There were obvious free zinc ions in the cells.EDTA 2.5 mmol· L-1 significantly increased the cell viability decreased by ZnO-NP 20 mg· L-1 (P＜0.05).Chelating free zinc ions significantly mitigated ZnO-NP induced cell toxicity (P＜0.05).CONCLUSION Cytotoxicity and apoptosis of Ana-1 cells induced by ZnO-NP might be related to intracellular uptake of ZnO-NP and release of zinc ions.

Objective:To evaluate whether underdilated stent could reduce the occurrence of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation.Methods:A total of 197 patients with decompensated liver cirrhosis, who had underwent TIPS creation at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were analyzed retrospectively, including 110 males and 87 females with age 25-79 (54±11) years old. Uncovered and covered stents with 8 mm diameter were implanted in all subjects, and then dilated by balloon catheters with 6 mm or 8 mm diameter. The patients were divided into two groups, including underdilated group (6 mm, n=105) and control group (8 mm, n=92).Kaplan-Meier curves were used to illustrate cumulative rate of HE, and the differences were assessed with the log-rank test. Multivariate analyses with a Cox regression model were conducted to explore the risk factors for HE. Results:During a median follow-up period of 29 (12-54) months, 16 (15.2%) patients developed HE in the underdilated group and 27 (29.3%) patients in the control group. There was a significant difference in the cumulative rate of HE ( P=0.014), but no statistical differences were found in terms of variceal rebleeding, shunt dysfunction and survival between the two groups ( P=0.608, P=0.659, P=0.968). In multivariated analysis, group assignment (underdilated vs. control, HR=0.291, 95% CI 0.125-0.674, P=0.004) was identified as an independent risk factor for HE after TIPS creation. Conclusion:Underdilated TIPS could reduced the risk of HE compared with completely dilated TIPS, with comparable risk of variceal rebleeding, shunt dysfunction and mortality. And it is worthy of applying this technique to a large sample of patients in clinical practice.

Objective:To explore the prognostic influencing factors of adult lymphoma-associated hemophagocytic syndrome (LAHS) based on multicenter data.Methods:The clinical data of 86 LAHS patients diagnosed in 9 medical centers of Huaihai Lymphoma Working Group from January 2015 to August 2020 were retrospectively analyzed. The optimal cut-off value of continuous variables was obtained based on MaxStat algorithm. Cox proportional hazard regression model was used for univariate and multivariate analyses. Kaplan-Meier method was used for survival analysis, and log-rank test was performed.Results:Among the 86 adult LAHS patients, 50 (58.1%) were males and 36 (41.9%) were females, the median age of the patients was 57 years old (19-76 years old), and the median overall survival (OS) time was 1.67 months (95% CI 0.09- 3.24 months). The most common pathologic type was diffuse large B-cell lymphoma (58 cases, 67.44%). Based on MaxStat algorithm, the optimal cut-off values of age, albumin, serum creatinine, lactate dehydrogenase, fibrinogen and platelet count were 64 years old, 30.1 g/L, 67 μmol/L, 1 045 U/L, 4.58 g/L and 72×10 9/L, respectively. Multivariate analysis showed that patient's age, lactate dehydrogenase, albumin and fibrinogen levels were independent influencing factors for OS (all P < 0.05). Conclusions:LAHS is dangerous and progresses quickly. Patients with age ≥ 64 years old, lactate dehydrogenase ≥ 1 045 U/L, fibrinogen ≥ 4.58 g/L and albumin < 30.1 g/L have poor survival.