Objective To investigate the predictive value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)radiomics combined with Magee equation 3(ME3)for pathological response following neoadjuvant chemotherapy(NAC)in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative(HR+/HER2-)breast cancer.Methods A ret-rospective analysis was performed on 325 breast cancer patients diagnosed with HR+/HER2-in two hospitals.Patients from the first hospital were randomly divided into training and internal validation sets at a ratio of 7∶3.Patients from the second hospital served as external validation set.The volume of interest(VOI)of breast cancer was delineated on DCE-MRI images.Then the rele-vant radiomics features were extracted and selected,and the Radiomics score(Radscore)was calculated.The statistically significant clinical and pathological features and Radscore were incorporated into a multivariate analysis.The combined radiomics-clinical model and nomogram were established,and the prediction performance was evaluated by using the receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis(DCA).Results In the training set,seven radiomics features were selected to construct the radiomics model.ME3 score emerged as the independent factor for pathological complete response(pCR)(P＜0.001).By integrating ME3 score and Radscore,a combined radiomics-clinical model was developed.This model demonstrated robust predictive accuracy,with area under the curve(AUC)of 0.88[95％confidence interval(CI)0.80-0.95],0.90(95％CI 0.82-0.98),and 0.82(95％CI 0.70-0.93)in the training,internal validation,and external validation sets,respectively.The nomogram construc-ted from the combined model exhibited excellent discrimination and calibration,with P-values of 0.455,0.312 and 0.062 in the train-ing,internal validation,and external validation sets.Conclusion DCE-MRI radiomics combined with ME3 can be used to predict the pathological response of NAC in HR+/HER2-breast cancer.

Objective To investigate the predictive value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)radiomics combined with Magee equation 3(ME3)for pathological response following neoadjuvant chemotherapy(NAC)in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative(HR+/HER2-)breast cancer.Methods A ret-rospective analysis was performed on 325 breast cancer patients diagnosed with HR+/HER2-in two hospitals.Patients from the first hospital were randomly divided into training and internal validation sets at a ratio of 7∶3.Patients from the second hospital served as external validation set.The volume of interest(VOI)of breast cancer was delineated on DCE-MRI images.Then the rele-vant radiomics features were extracted and selected,and the Radiomics score(Radscore)was calculated.The statistically significant clinical and pathological features and Radscore were incorporated into a multivariate analysis.The combined radiomics-clinical model and nomogram were established,and the prediction performance was evaluated by using the receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis(DCA).Results In the training set,seven radiomics features were selected to construct the radiomics model.ME3 score emerged as the independent factor for pathological complete response(pCR)(P＜0.001).By integrating ME3 score and Radscore,a combined radiomics-clinical model was developed.This model demonstrated robust predictive accuracy,with area under the curve(AUC)of 0.88[95％confidence interval(CI)0.80-0.95],0.90(95％CI 0.82-0.98),and 0.82(95％CI 0.70-0.93)in the training,internal validation,and external validation sets,respectively.The nomogram construc-ted from the combined model exhibited excellent discrimination and calibration,with P-values of 0.455,0.312 and 0.062 in the train-ing,internal validation,and external validation sets.Conclusion DCE-MRI radiomics combined with ME3 can be used to predict the pathological response of NAC in HR+/HER2-breast cancer.

A 63-year-old female patient received Ⅳ infusions of salvianolate,cattle encephalon glycoside,and pantoprazole and an intramuscular injection of diphenhydramine (only once) in Emergency Department for dizziness,nausea,vomiting,and weakness of lower limbs.Laboratory tests showed no abnormalities in liver function.Craniocerebral CT showed multiple lacunar ischemic demyelination and bilateral internal carotid atherosclerosis.The patient was diagnosed with lacunar cerebral infarction and admitted to hospital.On the night of admission,oral rosuvastatin calcium 10 mg/d and clopidogrel75 mg/d were given.Eleven hours later,laboratory tests showed aspartate aminotransferase (AST) 254 U/L and alanine aminotransferase (ALT) 157 U/L.Salvianolate and pantoprazole were discontinued and reduced glutathione was given.On day 3 of reduced glutathione treatment,laboratory tests showed AST 587 U/L and ALT 660 U/L.Rosuvastatin calcium-induced liver transaminase elevation was considered.Then rosuvastatin calcium was discontinued and compound glycyrrhizin was given.On day 9 of rosuvastatin calcium withdrawal,laboratory tests showed AST 112 U/L and ALT 201 U/L,and then reduced glutathione was discontinued.On day 15 of rosuvastatin calcium withdrawal,laboratory tests showed AST 42 U/L and ALT 63 U/L,and then compound glycyrrhizin was discontinued.The patient was discharged 4 days later.At 2 weeks of follow-up,no abnormalities in liver function were found in the patient.

A 63-year-old female patient received Ⅳ infusions of salvianolate,cattle encephalon glycoside,and pantoprazole and an intramuscular injection of diphenhydramine (only once) in Emergency Department for dizziness,nausea,vomiting,and weakness of lower limbs.Laboratory tests showed no abnormalities in liver function.Craniocerebral CT showed multiple lacunar ischemic demyelination and bilateral internal carotid atherosclerosis.The patient was diagnosed with lacunar cerebral infarction and admitted to hospital.On the night of admission,oral rosuvastatin calcium 10 mg/d and clopidogrel75 mg/d were given.Eleven hours later,laboratory tests showed aspartate aminotransferase (AST) 254 U/L and alanine aminotransferase (ALT) 157 U/L.Salvianolate and pantoprazole were discontinued and reduced glutathione was given.On day 3 of reduced glutathione treatment,laboratory tests showed AST 587 U/L and ALT 660 U/L.Rosuvastatin calcium-induced liver transaminase elevation was considered.Then rosuvastatin calcium was discontinued and compound glycyrrhizin was given.On day 9 of rosuvastatin calcium withdrawal,laboratory tests showed AST 112 U/L and ALT 201 U/L,and then reduced glutathione was discontinued.On day 15 of rosuvastatin calcium withdrawal,laboratory tests showed AST 42 U/L and ALT 63 U/L,and then compound glycyrrhizin was discontinued.The patient was discharged 4 days later.At 2 weeks of follow-up,no abnormalities in liver function were found in the patient.

Objective To investigate the efficacy and value of intra-operative neuromonitoring (IONM) in preventing,identifying and repairing recurrent laryngeal nerve injury (RLNI) during thyroidectomy and parathyroidectomy.Methods Data were collected from a series (n =351) of patients operated in our department between Jan 2015 and Dec 2017.Results With IONM navigation a total of 460 recurrent laryngeal nerves were identified during surgery.Anatomic variations were found in 6 cases,3 were non-recurrent laryngeal nerve.Others were morphological branching variation.There were 4 cases of temporary RLNI,all were unilateral.Total temporary RLNI rate was 1.1％.All 4 cases recovered completely in 3 months after surgery.Complete transection injury of RLN were found in 2 cases,one underwent immediate nerve anastomosis,with the voice significantly improved in 6 months.The total permanent RLNI rate was 0.5％.There was no hoarseness after operation in patients with normal IONM signal.The incidence of vocal cord paralysis was 57.14％ in patients with loss of IONM signal but normal appearance of RLN.Use of IONM did not increase operation time.Conclusions IONM had significant advantages in recognition of RLN,repair of intraoperative RLNI and prediction of postoperative voice condition,which could improve the safety of surgery.

Objective To detect the protein expression changes of mitochondrial apoptotic pathway during the reverse effects of lipid emulsion on bupivacaine cardiotoxicity, so as to investigate the probable mechanism concerning the reverse effect of lipid emulsion on bupivacaine cardiotoxicity.Methods The ventricular muscles of 15 healthy SD neonatal mice (1-3 d) were chosen to conduct primary culture in vitro.And the cardiomyocytes were cultivated in a medium containing bupivacaine for 24 hours to establish its bupivacaine poisoning model.The cultured cardiomyocytes were divided into three groups: control group (group C);bupivacaine group (group B);and bupivacaine+lipid emulsion group (group BL).Flow cytometry was applied to examine the apoptosis of cardiomyocytes, and the Western blot was employed to detect the protein expression variation of cytochrome C (Cyto-C) and cleaved casepase-3.Results Compared with group C, the apoptosis rate was remarkably increased in both group B and group BL and that of the group B was dramatically higher than that of the group BL, with a statistical significance (P<0.05).Compared with group C, the protein expression levels of both Cyto-C and cleaved casepase-3 were significantly increased in groups B and BL (P<0.05), and the protein expression levels of both Cyto-C and cleaved casepase-3 in group B were significantly higher than those in group BL (P<0.05).Conclusion Lipid emulsion can regulate apoptosis through inhibiting the release of mitochondrial Cyto-C and reducing casepase-3 activation, thus it protects cardiomyocytes.

ABSTRACT:Objective To investigate the nursing methods of artificial lens implantation by three points suspension in the treatment of aphakic eye.Methods 12 cases with aphakic eyes were included in this study.XLSTABI -SKY foldable artificial lens was implanted by suspension of three points in the second phase,and all the patients was followed-up by more than six months. Preparation before operations,human-based nursing during operations and individualized nursing after operations were done and complications were observed.Results Through the operation and special nursing,each patient got a better corrected visual acuity than that before operation,en-dothelial decompensation and endophthalmitis of artificial artificial lens were not observed.Conclu-sion Special nursing and education for patients with implantation of foldable artificial lens sus-pended by three points could improve visual acuity and satisfactory consequences.

ABSTRACT:Objective To investigate the nursing methods of artificial lens implantation by three points suspension in the treatment of aphakic eye.Methods 12 cases with aphakic eyes were included in this study.XLSTABI -SKY foldable artificial lens was implanted by suspension of three points in the second phase,and all the patients was followed-up by more than six months. Preparation before operations,human-based nursing during operations and individualized nursing after operations were done and complications were observed.Results Through the operation and special nursing,each patient got a better corrected visual acuity than that before operation,en-dothelial decompensation and endophthalmitis of artificial artificial lens were not observed.Conclu-sion Special nursing and education for patients with implantation of foldable artificial lens sus-pended by three points could improve visual acuity and satisfactory consequences.

Objective To research the effect of regulating systemic inflammatory response by using ulinastatin in elderly patients after sevoflurane inhalation of postoperation cognitive function. Methods 60 patients under went elective abdominal surgery, were randomly double-blinded divided into 2 groups. Every group had 30 patients.Group A accepted continuously intravenousiy infusion ulinastatin 2000 units · kg-1 · h-1 , while group B got equivalent continuously intravenous infusion 0.9% sodium chloride injection. The time point of opening eye, extubation, response and the mini-mental state examination(MMSE) score on different time points were observed. Meanwhile, the changes of concentration of hs-CRP, IL-6,IL-10 were measured. Results Compared with two groups,group A has shorter time on response(F =4.399,P = 0.040). Two both groups had decrease of MMSE score 1 hour after surgery compared with preoperation(t =7. 732,11. 916, both P ＜ 0.01), and the score were less than the preoperative value of more than 2 points which showed cognitive decline in patients. But group A's rate of decline in MMSE score was lower than group B(F = 7. 582 ,P =0.012). Both groups had the MMSE score decline 6h after surgery (t = 4. 606,8. 615, both P ＜ 0.05). Group A's score was less than the preoperative value for less than 2 points, group B's score was lower than the preoperative value for more than 2 points, but the difference between the two groups was not significant (P ＞0. 05). Both groups had higher concentrations of hs-CRP、IL-6 、IL-10 at postoperative 1 d ,3d ,7d (all P ＜ 0.01), peaked at postoperative 1 d, and hadn't come back to the preoperative level 7d*after surgery. In group A, the concentrations of hs-CRP, IL-6 increased (postoperative 1 d,3d), but the rate was lower than the group B (F = 14. 885, P = 0.000;F = 4. 405, P = 0. 040; F = 18. 204, P = 0.000; F = 8. 074, P = 0. 006); while the increased rate of concentration of IL-10 was higher than the group B(F=5.197,P=0.026;F= 12.236,P =0.000). Conclusion Ulinastatin could promote the elderly after sevoflurane inhalation rapid recovery of cognitive function, which may be related to the regulation of systemic inflammatory response.

Objective To explore and solve the problem of insufficiency and malformation due to cripple hand and defect of digital bone resulted of innate and injured. Evaluation to the methods of bone autografting combinated with flaps to reconstruct the deficient hand and digits. Methods Vascularized iliac bone or metatarsophalangeal joints (MPJ) or toes transplantation incorporated with flaps were used to reconstruct the defected bone in palm or fingers. Combined with tendon absence in such cases should be repaired or restituted by tendon autografting in one stage or by stages. Results Total 16 cases were treated by the methods metioned above. Except 1 of 16 was failure resulted in severe infection, the others were reconstructed successfully. 13 of 16 were followed up 8 months to 2 years, the evalution of the group from motion,sensation and appearance shew that the fine rate of motion was 53.8 percent, the rate of appearance and sensation were both 69 percent. Conclusion Vascularized iliac bone or metatarsophalangeal joints (MPJ) or toes transplantation incorporated with flaps are available to reconstruct the defected bone in palm or fingers, and can reduce disability effectively while obtain a satisfactory outlook and proper functions by those methods.