Objective To assess the value of ultrasound elastography (UE) in the differential diagnosis of benign and ma‐lignant breast masses.Methods Clinical data of 180 female patients with breast masses were collected. A total of 180 masses in these patients were detected by ultrasound (US) and UE to primarily identify the benign or malignant masses before surgery. The diagnostic coincidence rate and values of ROC curve were compared based on the postoperative pathologic results between the two diagnosis methods.Results Forty‐eight benign masses and 127 malignant masses were correctly diagnosed by UE ,and 38 benign masses and 112 malignant masses by US. The sensitivity ,specificity ,accuracy ,positive predictive value and negative predictive value were higher in UE group than in US group ,and there were significant statistical differences (P<0.05 for all). Furthermore ,the value of area under the ROC curve (AUC) in UE group was 0.926 ,significantly higher than that in US group (0.899) (Z=2.8 ,P<0.05).Conclusion UE has the advantages of high sensitivity ,specificity and accuracy in differential di‐agnosis of the nature of breast masses. In terms of some disadvantages of UE ,UE should be combined with US in the diagnosis of benign and malignant breast diseases.

The models of Cardiacglycoside-induced cardiotoxicity in guinea pigs were made by perfusing isolated heart with Langendorff appa- ratus. The free radicals generation in myocardium following the incidence of ventricular premative beat, ventricular tachycardia and ventricular fibrillation were measured respectively by the directed measurement with Electron Spin Resonance ( ESR ) techniques. The results showed the more severe toxicosis, the more much free radicals generate. Free radicals generated significantly in ventricular fibrillation and were scavenged by Superoxide dismutase ( SOD ) and sodium selenate.

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Objective:To compare the one-year postoperative visual quality after trifocal intraocular lens (IOL) implantation and monofocal IOL implantation.Methods:A cohort study was conducted.Forty-one eyes from 41 age-related cataract patients who underwent phacoemulsification extraction combined with IOL implantation in Nanjing Drum Tower Hospital from May 2017 to June 2018 were enrolled.The patients were divided into trifocal IOL group (20 eyes) receiving ZEISS AT LISA tri 839MP trifocal IOL implantation and monofocal IOL group (21 eyes) receiving ZEISS 603P monofocal IOL implantation according to their willingness.One year after surgery, uncorrected distant visual acuity (UCDVA), uncorrected intermediate visual acuity (UCIVA), uncorrected near visual acuity (UCNVA), best corrected distance visual acuity (BCDVA), distance corrected intermediate visual acuity (DCIVA) and distance corrected near visual acuity (DCNVA) were detected in both groups.The patient point spread function (PSF), modulation transfer function (MTF) cutoff frequency, Strehl ratio (SR), OQAS Ⅱ values at 100%, 20%, and 9% contrast (OV 100%, OV 20%, OV 9%) and objective scattering index (OSI) were measured by OQAS Ⅱ.Wavefront aberrations including total aberration (TA), total high order aberrations (tHOAs), spherical aberration, coma, trefoil aberration, total low order aberrations (tLOAs), defocus, and astigmatism were evaluated with the iTrace visual function analyzer.All aberrations were represented by root mean square.The visual acuity of operative eyes was measured with a phoropter, and defocus curves were drawn with visual acuity better than 0.5 LogMAR.The incidence of posterior capsular opacification (PCO) in the IOL region was quantitatively analyzed by Sellman method.Visual function was scored by visual function index (VF-14). This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School (No.2018-219-01). Written informed consent was obtained from each subject prior to any medical examination.Results:One year after the operation, UCIVA, UCNVA, DCIVA, and DCNVA of trifocal IOL group were significantly better than those of monofocal IOL group, and the differences were statistically significant (all at P<0.001). OQAS Ⅱ visual quality indicators showed that the MTF cutoff frequency, SR, OV 100%, and OSI values of trifocal IOL group were significantly higher than those of monofocal IOL group, showing statistically significant differences (all at P<0.001). No significant difference in wavefront aberrations was found between the two groups (all at P>0.05). Defocus curve showed that the LogMAR visual acuity of patients at -1.0 D, -1.5 D, -2.0 D, -2.5 D, -3.0 D, and -3.5 D (namely, 1 m, 66 cm, 50 cm, 40 cm, 33 cm, and 29 cm) in monofocal IOL group were significantly better than those in trifocal IOL group (all at P<0.05). There was a higher incidence of PCO in trifocal IOL group than monofocal IOL group, with a statistically significant difference ( χ 2=41.0, P<0.001). The VF-14 score of trifocal IOL group was 87.99±1.09, which was significantly higher than 81.49±1.67 of monofocal IOL group ( t=10.301, P<0.001). Conclusions:One year after trifocal IOL implantation, the full range of vision, subjective and objective visual quality of eyes are better than eyes implanted with monofocal IOL.

Objective:To investigate the inhibitory effect of indocyanine green (ICG) on biological behavior and transdifferentiation of human lens epithelial cells (HLECs) and its mechanism.Methods:HLECs were divided into blank control group, 5% glucose solution (GS) group and 0.5% ICG group, 1.5% ICG group and 2.5% ICG group, which were treated with balanced salt solution, 5% GS and 0.5%, 1.5% and 2.5% ICG solutions for 3 minutes, respectively, and then were incubated in fresh medium for 24 hours.The apoptosis level of HLECs was detected by flow cytometry.The expression levels of apoptosis-related proteins, Bcl-2-associated X protein (Bax), B-cell lymphoma-2 (Bcl-2), caspase-3 and caspase-9 were detected by Western blot.Cell proliferation was detected via the cell counting kit-8 (CCK-8) assay and 5-ethynyl-2'-deoxyuridine (EdU) incorporation assay.The migration ability of HLECs was detected by cell scratch assay.Cell migration and invasion were determined by Transwell assays.The expression levels transdifferentiation-related proteins, α-smooth muscle actin (α-SMA), nerve calcium adhesion protein (N-cadherin), fibronectin (FN) and vimentin were assessed by Western blot.Results:The apoptosis rates of blank control group, 5% GS group, 0.5% ICG group, 1.5% ICG group and 2.5% ICG group were (4.35±0.60)%, (4.63±0.19)%, (8.17±0.69)%, (13.90±0.33)% and (23.08±1.12)%, with a statistically significant difference in the overall comparison ( F=412.74, P<0.05). The apoptosis rate was significantly higher in 0.5% ICG group, 1.5% ICG group and 2.5% ICG group than in blank control group and 5% GS group (all at P<0.05). The relative expressions of caspase-3, caspase-9 and Bax proteins were significantly higher in 0.5% ICG group, 1.5% ICG group and 2.5% ICG group than in blank control group and 5% GS group, and the relative expression of Bcl-2 protein was lower in 1.5% ICG group and 2.5% ICG group than in blank control group and 5% GS group, and the differences were statistically significant (all at P<0.05). The rate of EdU-positive cells was significantly lower in 0.5% ICG group, 1.5% ICG group and 2.5% ICG groups than in blank control group and 5% GS group (all at P<0.05). The survival rate of cells was significantly lower in 0.5% ICG group, 1.5% ICG group and 2.5% ICG group than in blank control group and 5% GS group (all at P<0.05). The migration rates of scratch cells were significantly lower in 0.5% ICG group, 1.5% ICG group and 2.5% ICG group than in blank control group and 5% GS group, and the differences were statistically significant (all P<0.05). The number of migrating cells and the number of invading cells were significantly lower in 0.5% ICG group, 1.5% ICG group and 2.5% ICG group than in blank control group and 5% GS group (all at P<0.05). The relative expressions of α-SMA, N-cadherin and FN were significantly lower in 0.5% ICG group, 1.5% ICG group and 2.5% ICG group than in blank control group and 5% GS group, and the relative expression of vimentin was lower in 1.5% ICG group and 2.5% ICG group than in blank control group and 5% GS group, and the differences were statistically significant (all at P<0.05). Conclusions:ICG can promote HLECs apoptosis and inhibit HLECs proliferation, migration, invasion and transdifferentiation in a concentration-dependent manner.

Objective To explore the influence factor of the stability of L5S1 fusion and the relationship between the stability of sacrum fusion and the clinical outcome for degenerative lumber scoliosis with long-segment fusion.Metheds Fifty patients with degenerative lumber scoliosis who underwent the long-segment fusion from June 2010 to January 2015 were included in this retrospective study.Based on post-operative L5S1 fusion,patients were divided into two groups.There were 15 patients(30％,9 male and 6 female patients) with a failing sacrum fusion whose average age 60±7.6 years (range from 58 to 78 years).6 patients had the situation at T12-S1,7 at L1-S1 and 2 at L2-S1.There were 35 patients (70％,26 male and 9 female patients) with a satisfying sacrum fusion whose average age 58.4±4.8 years (range from 50 to 80 years).Among them,16 were at T12-S1,12 at L1-S1 and 7 at L2-S1 levels.The interbody fusion rate and accuracy of pedicle screws were evaluated by anteroposterior and lateral spine radiographs in standing and CT scanning during the postoperative follow-up.The age,body mass index (BMI),bone mineral density,Cobb's angel,lumbar lordosis (LL),sagittal vertical axis (SVA),thoracic kyphosis (TLK),sacral slope (SS),pelvic inclination (PI) and pelvic tilt (PT) were compared between the 2 groups to analysis the relevant factor of the failing L5S1 fusion.Oswestry disability index (ODI) and visual analogue scale (VAS) were compared between the 2 groups in the postoperative follow-up.Results There were no statistically significant difference between the 2 groups preoperative in the age,BMI,lumbar Cobb angel,LL,SVA,TLK,SS,PI and PT.But there was a significant difference between the bone mineral density of 2 groups.LL were-40.5°± 8.7° vs.-41.2°±7.9°;TLK were 1.7°±7.4° vs.1.8°±6.7°;SS were 32.1°±5.6° vs.32.4°±5.5°;PT were 18.7°±10.5° vs.19.5°± 10.1°;PI were 42.3°±4.4° vs.40.1°±5.2°;SVA were 9.2±3.5 cm vs.9.5±3.1 cm;T value were-2.7±1.1 vs.-1.2±1.4.There were no statistically significant difference between the 2 groups in the ODI and VAS in the postoperative follow-up.Oswestry disability index were 8.2％±5.2％ vs.7.8％±4.5％;VAS value were 3.4±2.6 vs.3.1±2.1.Conclusion The smaller the bone mineral density of the patients with DS,the higher the incidence of the fusion failure L5S1 fusion.And when the failing L5S1 of fusion happened,the clinical outcome will not always be poor.

ObjectiveTo explore the clinical efficacy of Gouteng prescription in treating the patients with primary hypertension with anxiety disorder due to yang hyperactivity and heat toxin and the impact of the formula on the balance of inflammatory cytokines. MethodA total of 98 patients diagnosed with primary hypertension and anxiety disorder were randomized into control and observation groups. On the basis of conventional western medicine treatment for hypertension， the control group （47 patients） was treated with Shugan Jieyu capsules for 8 weeks， while the treatment group （51 patients） with Gouteng prescription for 8 weeks. The two groups were compared in terms of the blood pressure level， 24-hour blood pressure variability， Hamilton anxiety scale （HAMA） score， Pittsburgh sleep quality index （PSQI） score， quality of life （SF-36 scale） score， traditional Chinese medicine （TCM） syndrome score and efficacy， incidence of adverse reactions， and the levels of interleukin （IL）-1β， IL-6， IL-10， and IL-4 in the serum of peripheral blood. ResultThe final trial was completed with 95 patients， including 46 in the control group and 49 in the observation group. The treatment in both groups lowered the blood pressure and blood pressure variability （P<0.05， P<0.01）. The observation group outperformed the control group in recovering the systolic blood pressure （SBP）， 24-hour mean systolic blood pressure （24 h SBP）， 24-hour systolic blood pressure variability （24 h SBPV）， and 24-hour diastolic blood pressure variability （24 h DBPV） （P<0.05）. After treatment， the HAMA and PSQI scores in both groups decreased （P<0.05， P<0.01）， and the observation group had lower HAMA and PSQI scores than the control group （P<0.05）. Compared with those before treatment， the SF-36 scores in both groups increased （P<0.05， P<0.01）. After treatment， the observation group had higher scores of physiological function （PF）， bodily pain （BP）， social function （SF）， role-emotional （RE）， and mental health （MH） indicators than the control group （P<0.05）. After treatment， the TCM syndrome scores in both groups decreased （P<0.05， P<0.01）， and the observation group had lower score than the control group （P<0.05）. The total response rate regarding TCM syndrome in the observation group was 85.71% （42/49）， which was higher than that （63.04%， 29/46） in the control group （χ²=6.621， P<0.05）. The treatment in both groups lowered the levels of pro-inflammatory cytokines （IL-1β， IL-6） and elevated the levels of anti-inflammatory cytokines （IL-10， IL-4） （P<0.05， P<0.01）， and the changes were more obvious in the observation group than in the control group （P<0.05）. There were no adverse events during the research process. ConclusionGouteng prescription can recover the blood pressure level， reduce blood pressure variability， suppress anxiety state， improve sleep and quality of life， decrease TCM syndrome score， increase total response rate， lower serum IL-1β and IL-6 levels， and elevate serum IL-10 and IL-4 levels in the patients with primary hypertension complicated with anxiety disorder due to yang hyperactivity and heat toxin. It may exert the effects by regulating the balance of pro-inflammatory and anti-inflammatory cytokines.