Objective To analyze the correlation between Ki-67 expression in tumor tissue and ultrasound features of patients with mass breast cancer.Methods A total of 90 patients(90 masses)with mass breast cancer admitted to Xinxiang Central Hospital from January 2020 to December 2022 were selected and divided into the Ki-67 high expression group(n=53)and Ki-67 low expression group(n=37)according to the expression of Ki-67 in tumor tissue.The qualitative and quantitative characteristics of contrast-enhanced ultrasound(CEUS),shear wave elastography(SWE)and color doppler flow imaging(CDFI)were compared between the two groups,and their correlation with Ki-67 expression in patients with mass breast cancer was analyzed by multivariate logistic regression.Results The proportion of CEUS perfusion defects patients in the Ki-67 high expression group was significantly higher than that in the Ki-67 low expression group(P＜0.05).There was no significant difference in CEUS margin,homogeneity,enhancement level,post-enhancement lesion range and direction between the two groups(P＞0.05).The maximum intensity,rise time,and half time in the Ki-67 high expression group were significantly higher than those in the Ki-67 low expression group(P＜0.05).There was no significant difference in arrival time,time to peak,and mean transit time between the two groups(P＞0.05).The proportion of hard ring signs in SWE of patients in the Ki-67 high expression group was significantly higher than that in the Ki-67 low expression group(P＜0.05),while there was no significant difference in the proportion of SWE black hole signs between the two groups(P＞0.05).The elastic modulus ratio between lesions to surrounding parenchyma of patients in Ki-67 high expression group was higher than that in the Ki-67 low expression group(P＜0.05).There was no significant difference in the maximum,average,and minimum elastic modulus between the two groups(P＞0.05).In the Ki-67 high expression group,the proportion of patient where tumor size under CDFI was 2-5 cm,and the proportion of patients with burrs on the lesion edge were higher than those in the Ki-67 low expression group(P＜0.05).There was no significant difference in the shape,location and calcification of the lesions under CDFI between the two groups(P＞0.05).Perfusion defect,hard ring sign and edge burr were associated with high Ki-67 expression in patients with mass breast cancer(P＜0.05).Conclusion Ultrasonographic features of mass breast cancer can predict Ki-67 expression.Perfusion defect,hard ring sign,and edge burr are related to Ki-67 positive expression.

Sjögren's syndrome （SS）， a disorder of immune system， is one of the dominant diseases treated by traditional Chinese medicine （TCM）. China Association of Chinese Medicine organized experts in the field of TCM and western medicine rheumatology and pharmacology to discuss the advantages and optimal regimens of TCM for the treatment of SS. The experts generally agreed on the low early diagnosis rate of SS and the lack of targeted therapeutic drugs. In addition， autoimmune abnormality is the key factor in the occurrence of SS and deficiency of both Qi and Yin is the core pathogenesis. SS has unique tongue manifestations， which is expected to allow for the early diagnosis and treatment with integrated traditional Chinese and western medicine. TCM has advantages in treating SS in terms of alleviating clinical symptoms and systemic involvement， individualized treatment， relieving sleep and mood disorders， preventing the occurrence in the early stage， and enhancing the effectiveness and reducing toxicity in the treatment by integrated TCM and western medicine. In general， TCM has advantages in different stages of SS. Internal and external use of TCM， acupuncture， and acupotome are all available options. The optimal regimens should be determined on the basis of pattern identification， stage of disease， and the advantages of TCM. Clinical characteristics and biomarkers of SS should be studied to classify patients， so as to design precision evidence-based TCM regimens for SS. On the basis of unique tongue manifestations of SS， models for early diagnosis and poor prognosis identification of SS should also be established to achieve early prevention and treatment and to improve the prognosis. In the future， we should vigorously carry out high-quality evidence-based medical research on the treatment of SS by TCM and integrated traditional Chinese and western medicine and develop relevant guidelines to optimize and standardize current diagnosis and treatment， thereby laying a basis for clarifying and explaining the advantages of TCM in treating SS.

Objective To observe the value of multimodal imaging for diagnosis of cardiac space-occupying lesions.Methods Data of 70 patients with cardiac space-occupying lesions who underwent echocardiography and cardiac CT(CCT)were retrospectively analyzed,among them 35 also underwent cardiac MRI(CMRI).The value of multimodal imaging for diagnosis of cardiac space-occupying lesions were explored according to the results of surgical pathology or clinical diagnosis.Results Among 70 cases,benign tumors were confirmed by surgical pathology in 43 cases,while malignant tumors were confirmed by surgical pathology in 3 cases and clinically diagnosed in 1 case.Meanwhile,non-tumor-occupying lesions were clinically diagnosed in 23 cases,all obviously shrunken after treatments.Among 70 cases,echocardiography correctly diagnosed 57 cases,misdiagnosed 8 cases and unclearly diagnosed 5 cases,with diagnostic accuracy rate of 81.43%(57/70).CCT correctly diagnosed 63 cases,misdiagnosed 4 cases but missed 3 cases,with diagnostic accuracy rate of 90.00%(63/70).CMRI outcomes in all 35 cases were consistent with surgical pathologic results,with diagnostic accuracy rate of 100%(35/35).Conclusion Multimodal imaging might provide objective evidences for diagnosis and treatment of cardiac space-occupying lesions.

Objective To explore the value of prenatal echocardiography in diagnosis of fetal ventricular septal defect (VSD).Methods Prenatal echocardiography was performed on 3 826 fetuses,and the results were compared with those of postnatal echocardiography or autopsy findings.The diagnostic accuracy,misdiagnosis rate and missed diagnosis rate of prenatal echocardiography for VSD were calculated.Results Among 3 826 fetuses,VSD was found in 61 fetuses (61/3 826,1.59％) with prenatal echocardiography,including simple VSD in 36 fetuses (36/3 826,0.94％) and VSD complicated with other heart malformations in 25 fetuses (25/3 826,0.65 ％).According to the results of autopsy and postnatal echocardiography,the final diagnosis of VSD was found in 76 cases (76/3 826,1.99％),of which simple VSD was found in 51 cases (51/3 826,1.33 ％),VSD complicated with other heart malformations were found in 25 fetuses (25/3 826,0.65％).The diagnostic accuracy,missed diagnosis rate and misdiagnosis rate of simple VSD with prenatal echocardiography was 58.82％ (30/51),41.18％ (21/51) and 1.06‰ (4/3 775),respectively.The diagnostic accuracy,missed diagnosis rate and misdiagnosis rate of VSD complicated with other heart malformations with prenatal echocardiography was 96.00％ (24/25),4.00％ (1/25) and 0.26‰ (1/3 801),respectively.Conclusion Echocardiography has important clinical value in prenatal diagnosis of fetal VSD,which can provide important references for treatment plan and prognosis evaluation.

Objective To investigate the correlation of ERα gene PvuⅡ ,XbaⅠ and ERβ gene RsaⅠ ,AluⅠ digestion polymorphism with coronary atherosclerotic heart disease(CHD) risk factors in Yancheng area .Methods A total of 124 cases of CHD and 163 persons undergoing physical examination served as the CHD group and CON group .The enzyme method was adopted to detect TG and TC .The direction method was adopted to detect HDL and LDL .ERα gene PvuⅡ ,XbaⅠ and ERβ gene RsaⅠ ,AluⅠ digestion polymorphisms were detected by adopting RFLP-PCR .Results The ratios of smoking history ,family history ,complicating hypertension and diabetes ,and the level of body mass index ,TC ,TG and LDLC in the CHD group were significantly higher than those in the control group ,the difference was statistically significant (P＜0 .05) .The various indicators had no statistically difference between male and female(P＞0 .05) .The frequency distribution and geographic distribution of ERα gene PvuⅡ ,XbaⅠ and ERβ gene RsaⅠ ,Alu Ⅰ digestion polymorphisms had no difference between the two groups ,all conformed to Hardy-Weinberg genetic equilibrium and had the group representativeness .pp ,xx ,RR and AA genotypes in the CHD group were maximal ,while PP , XX ,rr and aa genotypes were minimal ;Pp ,xx ,RR and AA genotypes in the CON group were maximal ,while PP ,XX ,rr and aa genotypes were minimal .The distribution frequency of p and x genes in the CHD group was significantly higher than that in the control group ,the difference was statistically significant(P＜0 .05) .Conclusion The estrogen gene polymorphism might be a target spot for effectively treating CHD ,and p and x gene distribution frequency may be related with CHD risk factors .

Objective To explore the effects of nurse-physician collaboration model on anxiety, depression and quality of life (QOL)of patients undergoing concurrent chemo-radiotherapy.Methods A total of 1 80 eligible patients from December 201 3 to December 201 4 were randomly divided into study group (n =96) and control group (n =84).The patients of study group received nurse-physician collaboration nursing,while the patients of control group received routine nursing.The self-rating anxiety scale (SAS ),self-rating depression scale (SDS ) and European organization for research and treatment of cancer quality of life questionnaire-3.0 (EORTC QLQ-C30)were used to investigate the differences between groups before and after intervention.Results Anxiety and depression in study group were better than those in control group after treatment,and the difference was statistically significant (P <0.05).Overall health,emotional function,social function,cognitive function,role function,pain,insomnia and breathing difficulties were better in study group than those in control group after treatment (P <0.05).Conclusions Nurse-physician collaboration model can improve the anxiety,depression and QOL of patients receiving chemoradiotherapy.

Objective This study intends to explore the impacts of the establishment of chest pain center(CPC) on the door-to-balloon(D-to-B) time in patients with ST-elevation myocardial infarction (STEMI) by different transfer ways to hospital. Methods A regular CPC and a regional cooperative network were established based on the pre-hospital transmitted real-time 12-lead electrocardiogram system. The STEMI patients were divided into the following three groups by the different transfer ways to hospital before and after the establishment of chest pain center:self-referral groups (group A1, n=52, and group A2, n=65), EMS (emergency medical service ) groups (group B1, n=31, and group B2, n=92) and transfer PCI groups (group C1, n=23, and group C2, n=552). The mean D-to-B time and the rate of D-to-B below 90 minutes were compared between before and after the establishment of CPC and the reasons of reperfusion delay were analyzed. Results There were no statistical differences of the average D-to-B time [(123±78) min vs.(140±123)min, P > 0.05] and the rate of D-to-B time below 90 min (44.2%vs. 46.2%) between group A1 and group A2. The average D-to-B time was significantly shortened in group B2 [(89±66)min] while compared with that in group B1 [(155±115)min, P<0.05] and the rate of D-to-B time below 90 min was remarkably elevated in group B2 compared with that of group B1 (69.6%vs. 32.3%, P<0.05). The average D-to-B time was significant shorter in group C2 than in group C1 [(77±43)min vs. (337±662)min, P<0.05] and the rate of D-to-B time below 90 min was remarkable higher in group C2 than in group C1 (75.7%vs. 21.7%, P<0.05). The longer D-to-B time in self-referral groups was mainly due to the delay of getting informed consent before PCI when occupied catheterization laboratory was the major cause of reperfusion delay in EMS groups and transfer PCI groups. Conclusions The establishment of CPC may significantly shorten the D-to-B time and increase the rate of D-to-B time below 90 min for these patients admitted by EMS and transferred from non-PCI hospitals. However, the pathway for the self-referral patients should be further modified.

Objective To evaluate the pre-hospital diagnostic reliability of real-time tele-transmission of 12-lead electrocardiogram of patients with ST-segment elevated acute myocardial infarction (STEMI).Methods The 12-lead electrocardiogram was simultaneously recorded with real-time tele-transmission system and a conventional electrocardiograph in 40 STEMI cases.The width and amplitude of each wave,the deviated amplitude of ST-segment in the same leads were compared by t-test and rank-sum test.Results There were no statistical differences in the width and amplitude of P wave,QRS wave and t wave as well as the deviated altitude of ST-segment between the two separate electrocardiographs (P ＞0.05).There was a significant positive correlation between the two ECG devices in respect of ST-segment elevated altitude (r =0.912,P =0.000).The differential ability of ST-segment elevation between two separate ECG devices kept highly consistent (Kappa value:0.976).Conclusions Real-time tele-transmission of 12-lead electrocardiogram is reliable for the pre-hospital diagnosis of STEMI.

Objective To explore the effect of cluster scalp acupuncture on pathological changes and the expression of nerve growth factor (NGF) and transforming growth factor (TGF) in rats after acute cerebral infarction.Methods30 male Wistar rats were randomly divided into the sham operation group (group A), model group (group B) and cluster scalp acupuncture group (group C) with 10 animals in each group. Animal model was made by the middle cerebral artery occlusion. The pathological changes and the expression of NGF and TGF in the brain tissues of rats were tested.ResultsOn the 7th day after operation, brain tissue of infarction area in the group B indicated significantly edema, neural cells decreased. Compared with the group B, the edema in the group C decreased and neural cells increased. At the same time, there were a few NGF and TGF expressions in hippocampus andcortex areas of the group A and group B, and there was no difference between the two groups ( P>0.05); but compared with the group A and group B, NGF and TGF in the group C increased significantly ( P<0.05, P<0.01).ConclusionCluster scalp acupuncture therapy can decrease edema, increase neural cells in infarction areas, as well as induce the expression of NGF and TGF in cortex and hippocampus.

ObjectiveTo study the rehabilitative effects and pathological changes in rats after acute cerebral infarction. Methods 30 male Wister rats were randomly divided into 3 groups :Group A(sham group),Group B(model group) and Group C(rehabilitation group). Animal model was made by the middle cerebral artery occlusion(MCAO).For each group, Bederson Neural Function was scored and balancing wood,rotating bar,and net screen were tested at 24 hours,3 days and 7 days after operation respectively. On the 7th day after operation, pathological change of brain tissue was observed. ResultsCompared with Group A, Bederson Neural Function scores of Group B,C indicated significant differences at each time (P<0.01).The abilities of grasping, walking and coordinating of all the groups after 24 hours by operation handicapped, however with time continuing,every function of Group A restored and that of Group B or C improved partly,but showed significant difference compared with Group A(P<0.01).After 3 days by operation,balancing wood test of Group C was better than that of group B(P<0.05),after 7 days,except Bederson Neural Function score,there were difference between Group C and B(P<0.05 or P<0.01).After 7 days by operation,compared with Group A,brain tissue of infarction area in Group B indicated significantly edema, neural cells decreased. Compared with Group B, the edema in Group C decreased and neural cells increased.ConclusionsRehabilitation therapy can improve the MCAO rats' ability of equilibrating, grasping and walking, and decrease edema, increase neural cells in infarction areas.