Objective:To explore the diagnostic value of digital mammography combined with serum glutathione specific gamma-glutamyl transpeptidase 1(CHAC1)and retinoic acid-induced protein 14(RAI14)in identifying benign and malignant breast masses.Methods:A total of 189 patients with breast masses who were treated at Handan Maternal and Child Health Care Hospital from June 2019 to June 2024 were prospectively selected as the research subjects.According to the results of pathological biopsy,they were divided into benign mass group(128 cases)and malignant mass group(61 cases).All patients underwent digital mammography detection.The levels of serum CHAC1 and RAI14 were detected by enzyme-linked immunosorbent assay(ELISA).The general clinical data of the patients were collected and analyzed.Multivariate logistic regression analysis was used to analyze the factors of influencing benign and malignant nature of breast masses.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of CHAC1 and RAI14 for the benign and malignant nature of breast masses.The Kappa test was used to assess the consistency of results between each diagnostic method and the pathological detection.Results:For 189 patients with breast masses,digital mammography identified 56 cases of malignant masses and 133 cases of benign masses,and 13 cases of them were misdiagnosis and 18 cases of them were missed diagnosis.It showed a moderate consistency with the results of pathological detection(Kappa=0.617,P<0.05).Compared with the benign mass group,the levels of serum CHAC1 and RAI14 in the malignant mass group were significantly higher,and the differences of them between the two groups were statistically significant(t=12.249,12.512,P<0.05).The age,menopausal time,CHAC1 and RAI14 of the patients were all risk factors that can affect the benign and malignant nature of breast masses(OR=1.368,1.305,1.897,1.995,P<0.05).The area under curve(AUC),sensitivity and specificity of CHAC1 were respectively 0.816(95%CI:0.753～0.868),70.49%and 89.06%in diagnosing the benign and malignant nature of breast masses.These indicators of RAI14 were respectively 0.838(95%CI:0.778～0.888),68.85%and 89.84%in diagnosing the benign and malignant nature.The combined detection of the three methods identified 74 cases of malignant masses and 115 cases of benign masses,with 15 cases of misdiagnosis and 2 cases of missed diagnosis,which showed an extremely high consistency with the results of pathological detection(Kappa=0.805,P<0.001).The sensitivity(96.72%),negative predictive value(98.26%)and accuracy(91.01%)of the combined detection of digital mammography,serum CHAC1 and RAI14 were significantly higher than those of each alone detection of them,and the differences of them were significant(x2=15.310,16.623,15.310,11.690,12.402,11.572,5.276,5.276,4.677,P<0.05).Conclusion:The levels of serum CHAC1 and RAI14 appear increase in malignant breast masses,and digital mammography combined with serum CHAC1 and RAI14 has a certain of identification value for benign and malignant nature of breast masses.

Objective:To explore the diagnostic value of digital mammography combined with serum glutathione specific gamma-glutamyl transpeptidase 1(CHAC1)and retinoic acid-induced protein 14(RAI14)in identifying benign and malignant breast masses.Methods:A total of 189 patients with breast masses who were treated at Handan Maternal and Child Health Care Hospital from June 2019 to June 2024 were prospectively selected as the research subjects.According to the results of pathological biopsy,they were divided into benign mass group(128 cases)and malignant mass group(61 cases).All patients underwent digital mammography detection.The levels of serum CHAC1 and RAI14 were detected by enzyme-linked immunosorbent assay(ELISA).The general clinical data of the patients were collected and analyzed.Multivariate logistic regression analysis was used to analyze the factors of influencing benign and malignant nature of breast masses.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of CHAC1 and RAI14 for the benign and malignant nature of breast masses.The Kappa test was used to assess the consistency of results between each diagnostic method and the pathological detection.Results:For 189 patients with breast masses,digital mammography identified 56 cases of malignant masses and 133 cases of benign masses,and 13 cases of them were misdiagnosis and 18 cases of them were missed diagnosis.It showed a moderate consistency with the results of pathological detection(Kappa=0.617,P<0.05).Compared with the benign mass group,the levels of serum CHAC1 and RAI14 in the malignant mass group were significantly higher,and the differences of them between the two groups were statistically significant(t=12.249,12.512,P<0.05).The age,menopausal time,CHAC1 and RAI14 of the patients were all risk factors that can affect the benign and malignant nature of breast masses(OR=1.368,1.305,1.897,1.995,P<0.05).The area under curve(AUC),sensitivity and specificity of CHAC1 were respectively 0.816(95%CI:0.753～0.868),70.49%and 89.06%in diagnosing the benign and malignant nature of breast masses.These indicators of RAI14 were respectively 0.838(95%CI:0.778～0.888),68.85%and 89.84%in diagnosing the benign and malignant nature.The combined detection of the three methods identified 74 cases of malignant masses and 115 cases of benign masses,with 15 cases of misdiagnosis and 2 cases of missed diagnosis,which showed an extremely high consistency with the results of pathological detection(Kappa=0.805,P<0.001).The sensitivity(96.72%),negative predictive value(98.26%)and accuracy(91.01%)of the combined detection of digital mammography,serum CHAC1 and RAI14 were significantly higher than those of each alone detection of them,and the differences of them were significant(x2=15.310,16.623,15.310,11.690,12.402,11.572,5.276,5.276,4.677,P<0.05).Conclusion:The levels of serum CHAC1 and RAI14 appear increase in malignant breast masses,and digital mammography combined with serum CHAC1 and RAI14 has a certain of identification value for benign and malignant nature of breast masses.

Objective To retrieve and analyze the evidences on insulin injection position selection and rotation in patients with diabetes, and to summary the best evidence. MethodsWe took "diabetes mellitus""insulin" "injection" "position" "rotation" as subject terms to retrieve the evidences on insulin injection position selection and rotation in the evidence-based database such as the British Medical Journal (BMJ) best practice, Uptodata, Cochrane Library (2014), Joanna Briggs Institute Library, Registered Nurses' Association of Ontario (RNAO), Scottish Intercollegiate Guidelines Network (SIGN) and National Guideline Clearinghouse (NGC) as well as the comprehensive database such as the Embase, Elsevier science Direct, PubMed, Web of Science, OVID, China Biological Medicine (CBM) and WanFang data. ResultsA total of 13 evidences were included, 2 evidence summaries, 7 guidelines and 4 consensus. Four kinds of evidence were summarized including training for insulin standardized injection and management, evaluation, injection position and rotation. ConclusionsMedical staff should standardize the clinical practice behavior in insulin injection position selection and rotation based on relevant levels of evidence-based medicine to guarantee the safety of patient and improve quality of nursing.

Objective To observe glomerular mesangial cells (GMCs) proliferation induced by IgA1 and the association with the expression of apoptosis-related proteins-B cell lymphoma-2 (Bcl-2),cysteine aspartic acid protease-3 (Caspase-3),cysteine aspartic acid protease-9 (Caspase-9) and with mitofusin 2 (Mfn2) in rat GMCs,to study the possible mechanism of valsartan inhibiting rat GMCs proliferation,and to provide a new direction for the mechanism of GMCs proliferation and intervention research in IgA nephrology (IgAN).Methods GMCs stimulated with IgA1 were cultured in vitro to detect cellproliferation with the cell counting kit-8 cell activity assay (CCK8).GMCs were divided into three groups:CG,TG and VG.The GMCs proliferation level was detected by the CCK8,using real-time PCR to detect Mfn2 expression and Western blotting to detect protein levels of Mfn2,Bcl-2,Caspase-3,and Caspase-9.Results Rat GMCs proliferated significantly after stimulation with IgA1,and IgA1 could obviously stimulate high expression of Bcl-2 in GMCs and down regulate the expression of Mfn2,Caspase-3,and Caspase-9.Valsartan could inhibit the proliferation of GMCs induced by IgA1 significantly,downregulate the expression of Bcl-2,and upregulate the expression of Mfn2,Caspase-3,and Caspase-9.Conclusions These results showed that the mechanism of action of valsartan in the treatment of lgAN is inhibiting the proliferation of GMCs.This mechanism may be associated with the regulation of apoptosis-related proteins,such as Mfn2,Bcl-2,Caspase-3,and Caspase-9.These findings may provide a new direction for the mechanism of GMCs proliferation and intervention research in IgAN.

Objective To observe the effects of combined surgeries for the correction of congenital ptosis accompanied by epicanthus.Methods 80 cases (105 eyes) of congenital ptosis were analyzed in this study.64 cases (80 eyes),with levator muscle strength more than 4 mm,were treated with suspension of frontal aponeurosis,and 16 cases (25 eyes),with levator muscle strength less than 4 mm,were treated with shorten operation of levator palpebrae superioris.Furthermore,all these patients were corrected the epicanthus at the same time.Results Except the under correction in 5 cases (8 eyes),the remaining patients were corrected satisfactorily.Postoperative palperbal fissure length was averagely increased by 2.0± 1.0 mm,inner canthic diameter was averagely decreased by 4.0± 2.0 mm,the eyelid height was increased by average 9.0±1.0 mm,the inclination of palpebral fissure was 12.0°±2.0°;64 cases (80 eyes) were treated with suspension of frontal aponeurosis,postoperative recurrence were 7.5％ (6/80),no postoperative recurrence were 92.5％ (74/80),complication were 5.0％ (4/80);16 cases (25 eyes) were treated with shorten operation of levator palpebrae superioris,postoperative recurrence were 8.0％ (2/25),and no postoperative recurrence were 8.0％ (2/25);complication rates were 4.0％ (1/25).Conclusions This procedure of combined surgeries can reduce the recurrence rate effectively.Moreover,the satisfactory,functional,and aesthetic results can be obtained simultaneously with this method.

Objective To evaluate the clinical effect of the individualized treatment of congential entropion.Methods Totally 150 patients (285 eyes) with congenital entropion were analyzed,the individualized procedures were performed,including the simple incision and suture surgery for simple congenital entropion,removing the redundant skin of lower eyelid for congenital entropion with redundant skin of lower eyelid but without epicanthus,the correction of entropion combined withY-V epicanthoplasty for congenital entropion with epicanthus and the recession of lower eyelid retractor for congenital entropion with lower eyelid retraction.The clinical effect,the percentage of cure and the complication of these cases were evaluated.Results The excellent results were achieved and no relapse or complications occurred in all cases.The total cure rate was 98.6％ (281 of 285 eyes).The cure rate of simple congenital entropion was 92.0％ (23 of 25 eyes).The cure rate of congenital entropion with redundant skin of lower eyelid was 100％ (41 of 41 eyes).The cure rate of congenital halflength entropion accompanied by epicanthus was 99.4 ％ (179/180 eyes).The cure rate of congenital entropion associated with lower eyelid retraction was 97.4％ (38 of 39 eyes).Conclusions Individualized operations not only have well curative effect for various congenital entropions,but recurrence rate and complications have been reduced.

Objective To explore the clinical efficacy of biapenem treatment of in hepatic failure complicated with bacterial infection.Methods 30 patients with hepatic failure complicated with bacterial infection were randomly divided into two groups.Treatment group were administered biapenem(Zhengda Tianqing Pharmaceuticals)0.6g/d,while the control group were administered cefopergone sodium tazobactam sodium for Injection(Qili Haikou Pharmaceuticals)4.0g/d for one week.Results There were significan differences in the curative rate and effective rate of biapenem and cefopergone sodium tazobactam sodium,which were 86.67％ 73.33％ and 53.33％ 、33.33％respeitively(P＜0.05).Conclusion Biapenem in treatment of hepatic failure complicated with bacterial infections was effective against infection with mild adverse reactions.

OBJECTIVE:To discuss the clinical features and the general pattern of drug-induced hepatic lesions.METHO-DS:The clinical data of 170 drug-induced hepatic lesion cases collected from Jan.2002 to Apr.2006 in our hospital were analyzed retrospectively.RESULTS:Of the 170 cases,35.29% were induced by Chinese herbal medicines,13.53% by antipsychotic drugs,12.94% by anti-tuberculosis agent;51.18% were hepatocellular damage type,14.12% cholestatic damage type and 34.71% damage of mixed type damage.CONCLUSION:Hepatic lesions resemble viral hepatitis and were of no specificity in clinical features;various drugs can lead to hepatic lesions and to which clinic should attach great importance.