It is difficult to diagnose early breast lesions from malignancy due to the pathological multiplicity and insidious clinical manifestations.The combined application of ultrasound-guided core-needle biopsy and ultrasound imaging has become an important approach to diagnose breast lesions from malignancy to benign lesions.By investigating the clinical characteristics of 427 cases undergone ultrasound imaging and ultrasound-guided core-needle biopsy,we conclude that besides the diagnosing skill of combined application itself,the corresponding moral principles should also be pondered on.

Objective The objective of this study is to describe the clinical features and outcomes of connective tissue disease (CTD) patients with mycophenolate mofetil (MMF) and with Pneumocystis jirovecii pneumonia (PJP).Methods We retrospectively reviewed the characteristics,clinical features,treatment and outcomes of PJP in patients with CTD.The clinical variables were compared between groups using t-test.Results ① A total of 17 cases were reviewed.② Sixteen patients were treated with glucocorticoids(GCs) plus immunosuppressive drugs.Only one patient had GCs without immunosuppressive drugs.Sixteen patients were with PJP,10 (63％) patients had MMF.③ Ten MMF patients and 7 non-MMF patients had absolute lymphocyte counts with the average being (557±170)/` and (926±162)/μl,respectively (t=-4.481,P＜0.05).④ Six of 17 patients died during the hospitalization.Five patients of 10 patients with MMF died 1 of 7 patients without MMF died.Fifteen of 17 patients were treated by trimethoprim-sulfamethoxazole (TMP-SMX).Conclusion MMF may be risk factors of PJP in CTD.

Objective To evaluate the effects of Shenmai injection on intrapulmonary shunt during one-lung ventilation in patients undergoing thoracic surgery.Methods Sixty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 40-60 yr,with body mass index of 18-25 kg/m2,scheduled for elective thoracic surgery,were randomly divided into 2 groups (n =30 each) using a random number table:control group (group C) and Shenmai injection group (group SM).Anesthesia was induced with midazolam,sufentanil,rocuronium,and etomidate.Starting from the end of induction of anesthesia until the time point immediately before one-lung ventilation,Shenmai injection 0.6 ml/kg (in 250 ml normal saline) was infused intravenously in SM group,and the equal volume of normal saline was given instead in C group.Immediately before one-lung ventilation,at 10 and 60 min of one-lung ventilation and at 10 min of two-lung ventilation,arterial and venous blood samples were collected for blood gas analysis and PaO2 was recorded.Intrapulmonary shunt (Qs/Qt) and alveolar-arterial oxygen pressure difference (P(A-a)DO2) were calculated.Results Compared with group C,PaO2 was significantly increased at 10 and 60 min of one-lung ventilation,and Qs/Qt and P(A-a)DO2 were decreased in group SM.Conclusion Shenmai injection 0.6 ml/kg infused intravenously before one-lung ventilation can reduce the intrapulmonary shunt during one-lung ventilation in patients undergoing thoracic surgery.

BACKGROUND:Although core decompression can contribute to the reconstruction of necrotic bone, its single use appears to have some deficiencies and cannot completely realize the reconstruction of the femoral head.
OBJECTIVE:To explore the effect of arthroscopic core decompression with autologous bone marrow induction material combined with titanium rod in the repair of stage II femoral head necrosis
METHODS:A retrospective analysis was performed on clinical data of 79 cases of stage II femoral head necrosis admitted at the South Branch of Tongchuan People’s Hospital from February 2011 to February 2013. According to the therapeutic methods, these cases were divided into control group (40 cases) and observation group (39 cases), and were given conventional core decompression and arthroscopic core decompression with autologous bone marrow induction material combined with titanium rod. Patients were fol owed up for 24 months, and the range of hip flexion and Harris scores on hip function and adverse events were observed and compared between two groups.
RESULTS AND CONCLUSION:Al the 79 patients successful y completed the 24-month fol ow-up. By the last fol ow-up, the range of hip flexion and Harris score were significantly higher in the observation group than the control group (P<0.05). There was no failure case due to surgical material rejection. To sum up, arthroscopic core decompression with autologous bone marrow induction material combined with titanium rod is safe and effective for repair of stage II femoral head necrosis.

Analysis on the cases demonstrated that the changes in their tongues possess some characteristics and changing regularity. As compared with the related ailments, indices of the proper and coating of the tongue presented very significant differeces. thus, the application of lingual picture in the diagnosis of perforation of the stomach and duodenum becomes feasible.

Objective We investigated the effect of VX-765 on collagen induced arthritis (CIA).Methods Twenty-four mice were divided into three groups:the VX-765 prophylaxis group (VX-765),the CIA model group (CIA) and the wild-type control group (Normal).Each group has 8 mice.Mice with CIA were in-tra-peritoneally injected with VX-765 (100 mg/kg,twice a day),mice with CIA and controls were treated with 0.9％ saline.At the end of the study,clinical scores,radiographic scores and histological scores of joints were calculated.Serum cytokine levels including interleukin (IL)-1β,IL-18,IL-33 were assessed by enzyme linked immunosorbent assay (ELISA).The serum cytokines levels between the CIA group and the VX-765 groups were compared using F test.The clinical scores,radiographic scores and pathological scores between the CIA group and the VX-765 group were compared using the Mann-Whitney test.Results The clinical scores of arthritis and the radiographic scores were significantly lower in the VX-765 group (1,1) than the CIA group (6.5,3.5;Q=4.5,2.75,P＜0.05).Compared with the CIA group,the histological analysis (1,5.5;Q=4.75,P=0.000),serum cytokine levels [IL-1β (2.0±1.0) vs (6.9±2.4) pg/ml,IL-18 (75±42) vs (129±48) pg/ml,IL-33 (145.46 vs 287.22) pg/ml] were significantly lower in the VX-765 group (F=27.98,F=17.27,Q=89.72,P＜0.01).Conclusion These findings suggest that caspase-1 is a potential therapeutic target for rheumatoid arthritis.

Objective To investigate the relationship between nucleo-tide-binding domain leucinerich-containing family pyrin domain-containing-3 (NLRP3) and the pathogenesis of arthritis.Methods The collagen-induced arthritis (CIA) mouse were divided into two groups:the model group (CIA,n=16) and the control group (n=8).The arthritis score and imaging evaluation (X-rays,Micro-CT) were performed;Synovial tissue NLRP3 expression were analyzed by immunohistochemical staining.Joint clinical score,radiographic score and joint NLRP3 expression were analyzed suing Pearson correlation analysis.Results The arthritis score (6.0±2.5),imaging score (4.6±0.9) and synovial tissue NLRP3 expression (4.0±2.0) were significantly increased in the CIA mice.The expression of synovial NLRP3 was positively correlated with arthritis clinical and radiographic scores (r=0.792,P＜0.05;r=0.669,P=0.005,respectively).Conclusion Synovial NLRP3 expression level is correlated with the clinical arthritis severity and extent of radiological destructions,suggesting that NLRP3 is involved in the pathogenesis of CIA.

ObjectiveTo observe the effect of mycophenolate mofetil(MMF) on systolic pulmonary arterial pressure (SPAP), right ventricle index (RVI), cytokines, receptors of pulmonary artery hypertension (PAH) rat models. MethodsThe rat models of monocrotaline (MCT)-PAH were developed. Thinty-two Sprague-Dawley male rats were divided randomly into four groups: the control group, the MCT, the MCT +low-dose MMF (20 mg·kg-1·d-1, MMF 20) and the MCT + high-dose MMF(40 mg·kg-1·d-1, MMF 40).There were eight rats in each group. SPAP, RVI, cytokines and receptor in the serum and lung tissue were measured in all rats. Comparisons between multiple groups were performed with q test and rank sum test.Results① Low-dose and high-dose MMF group were compared with the MCT group, SPAP[(40±13),(53±10) vs (68±10) mm Hg]and RVI(0.36±0.06, 0.38±0.03 vs 0.44±0.05) were reduced and showed statistically significant difference respectively(P＜0.05). (②) Compared with the MCT group, basic fibroblast growth factor(bFGF) of serum in both low-dose and high-dose MMF group were reduced and showed statistical difference respectively[(2.3±1.9), (2.7:t±1.3) vs (6.9±5.4) pg/ml, P＜0.05]. ③ Low-dose and high-dose MMF group were compared with the MCT group and showed that MA was decreased and the musculization of arterial wall was improved. ConclusionMMF can reduce SASP, RVI, number of MA. The inhibitory effect of MMF in PAH is possibly by inhibiting cytokines and receptors.

Objective The aim of this study was to detect the serum 25-hydroxyvitamin D (25-OH-D)and anti-vitamin D levels in new cases of systemic lupus erythematosus (SLE),and to investigate their clinical significance.Methods Fifty patients who fulfilled the ACR criteria for the classification of SLE and 36 healthy donors were included.Enzyme-linked immunosorbent assay was performed for serum 25 [OH] D and anti-vitamin D level measurement.Statistical methods used were t-test and Pearson's correalation analysis.Results The serum 25-OH-D level in SLE was (13±6) ng/ml,and the level in healthy donors wase (17±8)ng/ml,P =0.007); the difference was statistically significant.A significant negative correlation was demonstrated between the serum level of vitamin D and the 24 h urinary protein excretion (r=-0.314,P＜0.01),and the level of serum creatinine (r=-0.322,P＜0.01).Anti-vitamin D antibody was detected in 6 of 50 patients with SLE,in 10 of 36 sera from healthy donors.There was no difference of 25-OH-D level between the anti-vitamin D antibody positive group and anti-vitamin D antibodu negative group [(13±6) and (14±6) ng/ml in the SLE group; (17±6) and (18±9) ng/ml in the healthy control group].Conclusion The serum 25-OH-D level in SLE is low; however,it is not correlated with Anti-vitamin D antibody,but is correlated with renal lesions.So the serum 25-OH-D level may be important in the pathogenesis of SLE.

Objective To investigate the effect of argenin-glycin-aspartic acid (RGD) peptides on islet viability and function. Methods Rats were randomly divided into 2 groups: 1640 group and RGD group. Ficoll was used to purify islet in a discontinuous-density-gradient way. Islet concentration is 27% ,25% ,23% ,20.5% and 11% respectively. Acridine orange/ethidium bromide(AO/EB) fluorescent staining method was adopted to observe the effect of RGD peptides on islet viability. Radioimmunoassay was adopted to detect insulin level and measure insulin secretion index (SI). Caspase-9 cells and phospho-Akt 473-positive cells were determined by flow cytometry to investigate the influence of RGD peptides on caspase-9 activity and Akt. Results 600-700 IEQ islet was extracted from each rat by Ficoll purification through modified gradient centrifugation. AO/EB stain showed islet survival rate was more than 95% immediately after separation. Islets cultured in the medium of RPMI-1640 showed SI of 1.64 ±0.28 after 1 week, while islets cultured in the medium of RPMI-1640 containing RGD peptides showed SI of 2.28 ± 0.16 (P ＜ 0.05 ). Flow cytometry showed the level of activated caspase-9 was ( 22.66 ± 3.56 ) % if islet was cultured in RPMI-1640 alone for 1 week while the level was( 10.54 ± 1.96) % if islet was cultured in RPMI-1640 containing RGD peptides. There was statistical difference ( P ＜ 0. 05 ). The effect of RGD on Akt phosphorylation was also detected. Akt phosphorylation proportion was (31.47 ±4.08)% 1 week after cultured in RPMI-1640 while the value was(61. 054 ±6.03)% if cultured in RPMI-1640 containing RGD peptides. The difference had statistical significance (P ＜ 0. 05). Conclusion RGD peptides could inhibit apoptosis through the phosphorylation of Akt/PKB.