Objective:To investigate the prognostic value of tumor infiltrating lymphocytes (TILs) and their phenotypes, CD4 + TILs, CD8 + TILs and FOXP3 + TILs, in short-term prognosis (PCR) and long-term prognosis (DFS, OS) of triple negative breast cancer (TNBC), and to provide theoretical support for the immunotherapy of TNBC. Methods:A systematic surch of PubMed, Medline, Embase, Web of Science, CBM, CNKI was conducted to identified eligible articles. All prospective trials and observational controlled trials published before August 2020 were retrieved.The two authors independently evaluated the quality of the included literature, extracted the data, and conducted systematic evaluation and analysis using RevMan5.3 software.Results:A total of 48 literatures were included.Every 10% increase in TILs and TILs expression in the high-expression group predicted a higher PCR, OR were 1.81 (95% CI: 1.44-2.28) and 1.09 (95% CI: 1.02-1.15). For longer survival, the HR for DFS and OS were 0.99 (95% CI: 0.98-0.99) and 0.90 (95% CI: 0.86-0.94), 0.87 (95% CI: 0.79-0.96) and 0.88 (95% CI: 0.83-0.92). Phenotypic CD4 + TILs, CD8 + TILs, and FOXP3 + TILs did not show statistically significant differences in PCR among patients, but in long-term prognosis, higher infiltration predicted longer survival, with HR for DFS of 0.54 (95% CI: 0.36-0.80), 0.46(95% CI: 0.33-0.64) and 0.45(95% CI: 0.31-0.68). HR of OS were 0.49 (95% CI: 0.32-0.76), 0.59 (95% CI: 0.54-0.66) and 0.44 (95% CI: 0.27-0.71). Conclusion:The infiltration degree of TILs and the increase of TILs expression by 10% can be used as a prognostic index of TNBC.High levels of phenotypic infiltration of CD4 + TILs, CD8 + TILs, and FOXP3 + TILs predicted better long-term survival, but there was no statistically significant difference in short-term survival.

Objective: To investigate the current basic situation of ultrasound machines of ultrasound departments in Shanghai medical institutions, and to provide the basis for making management policy in order to promote medical quality. Methods: Questionnaire surveys about ultrasound machines and service ability including producing countries of ultrasound machines, the number of ultrasound machines, using years of ultrasound machines, yearly workload and the yearly number of patients that each ultrasound machine accepted were made in 2013 and 2018, respectively. Statistical results were compared between the two surveys. Results: Compared with 2013, the share of imported ultrasound machines declined in 2018 (82% vs 91%). Compared with 2013, the number of ultrasound machines in Shanghai medical institutions had increased by 31% in 2018 (2 123 vs 1 617). The occupancy rate of ultrasound machines in tertiary hospitals was the highest (tertiary hospitals 40%, secondary hospitals 25%, primary grade hospitals 20%, and private hospitals 15%). Compared with 2013, the proportion of ultrasound machines that have been used for more than 10 years increased (9% vs 4%), the yearly workload of ultrasound examination had increased by 46% (19.82 million person-time vs 13.59 million person-time). Tertiary hospitals bored the highest proportion of the workload (tertiary hospitals 51%, secondary hospitals 35%, primary grade hospitals 4%, and private hospitals 10%). Currently, the number of ultrasound machines per 10, 000 people in Shanghai was 1.14. The yearly number of patients that each ultrasound machine accepted had increased by 11% (9300 person-time vs 8400 person-time in 2018). Conclusions The scale of ultrasound departments in Shanghai medical institutions has been developing. Brand localization of ultrasound machines is improving. However, the renewal ability of ultrasound machines still needs to be improved. The workload of ultrasound department is getting heavier. Hierarchical diagnosis and treatment is unbalanced.

Edong Healthcare Group is cited as an example to summarize its practice of centralized purchasing of supplies in the recent two years.In addition to a success in its process and mechanism, the authors analyzed some challenges for the purpose of furthering the group-based reform of public hospitals.

Objective To investigate the value of three-dimensional speckle tracking imaging (3D-STI) in quantitative evaluation of left ventricular global strain in patients with atrial septal defect (ASD) before and after transcatheter closure.Methods Totally 35 patients with secondary ASD who received successful transcatheter occlusion were selected.Routine echocardiography and 3D-STI examination were performed before the operation,2 days,1 month,3 months and 6 months after the operation.Routine echocardiography was used to obtain the parameters of left ventricular end diastolic diameter (LVEDD),left ventricular end systolic diameter (LVEDS),left ventricular end diastolic volume (LVEDV),left ventricular end systolic volume (LVESV),stroke volume (SV) and other parameters.The left ventricular global peak longitudinal strain (GPLS),left ventricular global peak circumferential strain (GPCS),left ventricular global peak radial strain (GPRS) and left ventricular global peak area strain (GPAS) were examined with 3D-STI.The preoperative and postoperative parameters at each time point were analyzed statistically.Results Routine echocardiography showed that LVEDD,LVEDS,LVEDV,LVESV and SV increased significantly after operation,but no significant difference was found to compare each other 2 days,1 month,3 months and 6 months after operation (all P＞0.05).3D-STI examination showed that left ventricular GPLS,GPCS,GPRS and GPAS increased after operation,and the most increase was noticed at the second day after transcatheter occlusion.GPLS,GPCS and GPAS 6 months after operation were larger than those 3 months after operation (all P＞0.05).Conclusion 3D-STI technique can evaluate the left ventricular global strain in patients with ASD before and after occlusion.Compared with conventional echocardiography,3D-STI technique can objectively and effectively evaluate the changes of left ventricular systolic function.

Objective To investigate the change features of the 3-dimensional speckle tracking imaging (3D-STI) for quantitative evaluation of whole strain of left ventricular before and after left atrial appendage closure in the patients with non valvular atrial fibrillation and to evaluate its clinical application value.Methods Thirty patients who received left atrial appendage (LAA) closure from June, 2016 to A-pril, 2017 in Changhai Hospital were enrolled as research subjects .The patients received routine ultrasonic cardiography and 3D-STI, and left ventricular fractional shortening (LVFS), left ventricular ejection fractions (LVEF), global peak longitudinal strain (GPLS), global peak circumferential strain (GPCS), global peak radial strain (GPRS)as well as global peak area strain (GPAS) were respectively detected before surgery, 2 days, 1 and 3 months after surgery.Results In the 30 patients who received LAA closure, LVFS and LVEF were evaluated by u-sing routine ultrasonic cardiography and the data detected before surgery , 2 days, 1 and 3 months after surgery were compared between the two, and results showed that there was no statistical significance, when comparisons were made between them (P>0.05).In the 30 patients who were implemented with LAA closure, GPLS, GPCS, GPRS and GPAS values were detected using 3D-STI.The detected data 2 days after surgery were significantly higher as compared with those before surgery and 1 and 3 months after surgery(e.g.GPAS:39.90 ±10.22/27.80 ± 5.00, 26.20 ±6.05, 27.60 ±7.58), and there was statistical significance, when comparisons were made between them (P<0.05).However, there was no statistical significance in the data of GPLS, GPRS, GPCS and GPAS detected before surgery and 1 and 3 months after surgery, when comparisons were made between the two (P>0.05).Conclusion 3D-STI could be used for quantitative evaluation of the changes in left ventricular systolic function before and after LAA closure.The whole strain of the left ventricle of the patient was considerably increased 2 days after surgery, and the whole strain of the left ventricle recovered to pre-surgical level one month after surgery.

Objective: To explore the application of real-time three-dimensional ultrasound in locating the course, the brand and the blind end of internal opening of congenital preauricular fistula. Methods: Congenital preauricular fistula patients from Changhai Hospital were studied. All the cases were evaluated using two-dimensional and three-dimensional ultrasound before surgeries. The surgery findings were utilized as the gold standard. The imaging features of 3D ultrasound were described to determine the accuracy of the blind end location, the course of the main fistula tract and the branch tracts. The diagnosis was compared with the surgery findings. Results: In 89 cases, among which there were 21 branch fistulae. There were 68 bend fistulae without branch. The diagnostic accuracy of both two-dimensional ultrasound and three-dimensional ultrasound was 100%. The accuracy in locating the blind end of internal opening, the course of the branch tracts with 3D ultrasound was 92.1%(82/89), 85.7%(18/21) , compared to 80.9%(72/89), 57.1%(12/21) with 2D ultrasound. It was obvious that 3D ultrasound had more advantages. These differences were statistically significant (χ²=4.8, P<0.05; χ²=4.2, P<0.05). Conclusions Compared with 2D ultrasound, 3D ultrasound can accurately locate the blind end of internal opening, the course, and the branch of preauricular fistula, clearly display the morphology and the spatial structure of preauricular fistulaand its surroundings. It has high clinical application value in preoperative imaging examination.

Objective To explore whether strain elastography could improve the classification diagnosis of US BI -RADS 4A breast pathologic lesion .Methods Eighty-seven breast foci of the 75 patients diagnosed with the two-dimensional color Doppler ultra-sonography as BI-RADS 4A were selected for the study , and then, strain elastography was performed .The modified 5-point method was used for further evaluation , and BI-RADS classification was performed again with the help of the two-dimensional color Doppler ultra-sonography.The cases with the scores of ≥4 were upgraded as the 4B-C grade, the cases with the scores of =3 remained in the same grade, and the cases with the scores of <3 were downgraded to be the third grade .The results were compared with the pathological re-sults.Results Of the 87 breast lesions, 6 were evaluated to have elasticity scores of ≥4, 11 were assessed to have elasticity scores of=3, and 70 were assessed to have elasticity scores of <3.There were 8 malignant tumors confirmed by pathological examination in the 87 breast lesions, of which 8 lesions had elasticity scores of ≥4, 3 lesions had elasticity scores of =3, and 2 lesions had elasticity scores of <3.With the elasticity scores of ≥3 and <3 as the standards for respectively malignant and benign tumors , the sensitivity, specificity and accuracy of the method for detecting malignant tumors were respectively 75%, 86.1% and 85.1%, and the negative predictive value (NPV) was 97.1%, which was superior to that of conventional ultrasonography (P<0.05).With further classification of BI-RADS in combined use of elastography , the malignancy rate in the benign group was reduced to 2.8%and the malignancy rate in the malignant group was increased to 35.3%, and significant differences could be noted , when compared with those previous figures ( P<0.05).Conclusion Elastography could effectively promote the classification diagnostic accuracy of BI -RADS 4A breast pathologic lesion
and could considerably reduce the rate of biopsy before surgery .With this reason , it promised good clinical application .

Objective To conduct the epidemiological investigation and analysis of cerebral palsy in Xinxiang of Henan Province and to investigate its risk factors in order to provid a basis for further study of etiology and prevention of cerebral palsy information.Methods Cluster sampling survey was carried out among children aged 1-6 years in XinXiang,Henan Province,and the data were analyzed by using SPSS 13.0 statistical analysis software.Results The morbidity of infantile cerebral palsy in Xinxiang of Henan Province was 2.82‰.The prevalence distribution in all age groups was 2.46 ‰-3.11‰(x2 =0.374,P =0.996),and the prevalence rate in male and female was significantly different(x2 =0.139,P =0.709) ; the sex ratio was 1.09 ∶ 1.00.Prevalence rate was slightly lower in urban areas than in rural areas (x2 =0.526,P =0.769).But no significant differences were observed in all of the data above.The incidence of cerebral palsy of children whose mothers did not established perinatal care manual and guidance during pregnancy was 5.86 times of the children whose mothers established perinatal care manual and guidance (x2 =116.806,P =0.000) ;the incidence of cerebral palsy in children whose mothers did not receive regular prenatal care during pregnancy was 5.37 times of the children whose mothers receive regular prenatal care during pregnancy (x2 =43.904,P =0.000);the incidence of cerebral palsy in children who had no neonatal follow-up after birth was 8.55times of the children with neonatal follow-up after birth (x2 =68.987,P =0.000).The incidence of cerebral palsy in children whose developmental disorders were not timely diagnosed and treated medically was 5.39 times the children whose developmental disorders were timely diagnosed and treated (x2 =56.003,P =0.000).The significant differences were observed in all of the data above.In the classification of cerebral palsy,the spastic type was the most (42.1％) ;followed by the dyskinetic (24.6％) ; the mixed (18.8％) ; and the ataxia(14.5％).Conclusions The survey results can reflect current prevalence of infantile cerebral palsy in children aged 1-6 years in XinXiang,and can be served as a basis for further prevention and treatment of cerebral palsy information.

Objective To investigate the correlation between serum osteocalcin and type 2 diabetes mellitus (T2DM) in elderly patients.Methods A total of 55 T2DM patients (diabetic group) and 50 non-diabetic subjects (control group) aged ≥60 years were enrolled in this study.The levels of fasting blood glucose (FBG),glycated hemoglobin (HbAlc),insulin resistance index (HOMA IR),osteocalcin (OC),body mass index (BMI) and bone mineral density (BMD) in groups were compared.The correlations between serum osteocalcin and the above indicators were analyzed.Results The levels of OC and BMD were higher in control group than in diabetic group [(11.2±3.2)μg/Lvs.(4.1±3.0)μg/L,(-1.3±0.3) vs.(-2.6±0.5),respectively,both P＜0.05].The levels of FBG,HbAlc,FINS,HOMA-IR were lower in control group than in diabetic group [(4.7±2.0) mmol/L vs.(9.4±2.1) mmol/L],[(4.8±1.5) ％ vs.(7.6±1.6)％,(7.4±3.2) U/L vs.(23.7±3.0) U/L,(1.5±0.7) vs.(9.9±1.2),respectively,all P＜0.05].Serum osteocalcin concentration was negatively correlated with the levels of FBG,HbAlc,FINS and HOMA-IR in elderly patients with T2DM (r=-0.739,-0.713,-0.613,-0.092,all P＜0.01).Conclusions Serum osteocalcin concentration is correlated with the levels of blood sugar and insulin resistance index in elderly patients with T2DM.A further study on the correlation between osteocalcin and T2DM may provide a new target for the treatment of type 2 diabetes mellitus.