Objective To investigate the efficacy and safety of intravenous thrombolysis with low-dose and standard-dose recombinant tissue plasminogen activator(rt-PA)in the elderly patients(aged over 80 years)with acute ischemic stroke(AIS).Methods A total of 201 elderly patients with AIS treated at Tianjin Fourth Central Hospital from February 2019 to February 2023 were prospectively included and randomly assigned to the rt-PA low-dose group(n=93,0.6 mg/kg)and rt-PA standard-dose group(n=108,0.9 mg/kg).The incidence of intra-cranial hemorrhage,symptomatic intracranial hemorrhage,fatal intracranial hemorrhage,neurologic deterioration within 7 days and mortality within 90 days were observed to evaluate the safety.The neurologic improvement rate and good prognosis rate at 90 days were used to evaluate the effectiveness.A stratified analysis of 90-day outcomes was performed based on stroke severity and age.Results The incidence of intracranial hemorrhage,symptomatic intracranial hemorrhage and fatal intracranial hemorrhage within 7 days in rt-PA low-dose group was lower than that in rt-PA standard-dose group(P＜0.05).There were no statistically significant differences between the two groups concerning the residual safety index and the effectiveness index.The 90-day good prognosis rate of moderate stroke sub-group and of≥90 years of age sub-group in rt-PA low-dose group were both higher than that of rt-PA standard-dose group(P＜0.05).Conclusions For AIS patients with moderate stroke and aged over 90 years,intravenous thrombolytic therapy with rt-PA 0.6 mg/kg is recommended.

Objective To use metabolomics method to study the metabolic profiles of amino acids and lysophosphatidylcholine(LPC)in the serum of rats with nonalcoholic fatty liver disease(NAFLD),to identify biomarkers for NAFLD,and to speculate on the possible mechanism responsible for its occurrence.Methods NAFLD rats were prepared by feeding a high-fat diet and intraperitoneal injection of carbon tetrachloride.Levels of 15 LPCs and 18 amino acids in the serum were determined in control and NAFLD rats by liquid chromatography-mass spectrometry.Changes in serum LPC and amino acid metabolic profiles in NAFLD rats were analyzed by principal component analysis and orthogonal partial least squares discriminant analysis.Correlations between biomarkers and NAFLD were analyzed by Pearson's correlation analysis.Results The metabolic profiles of serum LPC and amino acids differed significantly between the NAFLD group and the control group and were completely distinct.LPC(20∶1),arginine,and glutamic acid had significant contributions to NAFLD and were identified as biomarkers.Furthermore,LPC(20∶1)and arginine were significantly correlated with serum biochemical indicators such as aspartate transaminase,alanine transaminase,low-density lipoprotein,and total bilirubin.Conclusions The metabolic profiles of serum LPC and amino acids may be closely related to NALFD.

Objective To analyze the application value of a Nomogram model established on clinical and ultrasound features of thyroid in modifying classification results of the Chinese Thyroid Imaging Reporting and Data System (C-TI-RADS) by ultrasound physicians. Methods The clinicopathological ultrasound materials of patients with surgical resection for thyroid nodules in Sichuan Provincial People's Hospital (training set, n=841) and Sichuan Mianyang 404 Hospital (external validation set, n=295) from January 2021 to December 2022 were retrospectively analyzed, and preoperative thyroid ultrasound was used to classify thyroid nodules by C-TI-RADS. Univariate and Multivariate Logistic regression analyses were used to screen independent predictors in the training set and a Nomogram model was constructed, and Bootstrap resampling was used for internal validation; ultrasound physicians in Sichuan Mianyang 404 Hospital were charged in external verification based on this Nomogram model. Receiver operating characteristic (ROC) curve and calibration curve were drawn to evaluate the efficacy of the model and its clinical value in modifying the classification results by C-TI-RADS. Results Univariate and Multivariate Logistic regression analyses showed that gender, age, maximum diameter of nodules, the number of nodules, ultrasound abnormalities of cervical lymph nodes and C-TI-RADS classification were the independent factors for predicting the modified classification results of C-TI-RADS by ultrasound physicians (P < 0.05). Consistency index of the Nomogram model constructed based on these factors was 0.842 (95%CI, 0.816 to 0.867), the area under the curve (AUC) was 0.842, sensitivity was 92.9%, specificity was 63.7%, and accuracy was 75.9%. The prediction results of the Nomogram model were in good agreement with the actual situation in both the training set and the external validation set. Conclusion Nomogram model based on clinical and ultrasound features of thyroid shows good predictive accuracy in modifying classification results of C-TI-RADS by ultrasound physicians, which has potential clinical application value.

Objective:To investigate the efficacy and safety of recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis combined with edaravone dexborneol at different timing in super elderly patients (aged≥85 years) with moderate to severe acute ischemic stroke (AIS).Methods:A prospective study was performed. Seventy-one super elderly patients with moderate to severe AIS treated with rt-PA intravenous thrombolysis combined with edaravone dexborneol from December 2020 to March 2023 in Department of Neurology, Affiliated Fourth Central Hospital of Nankai University were selected and randomly divided into early group ( n=35) and advanced group ( n=36); patients in the early group were given edaravone dexborneol immediately after rt-PA intravenous thrombolysis, and patients in the advanced group were given edaravone dexborneol 24 h after rt-PA intravenous thrombolysis. In addition, 31 patients with moderate to severe AIS received rt-PA intravenous thrombolysis only in Department of Neurology of the hospital from August 2018 to December 2020 were selected as control group. Differences in efficacy and safety indexes among the 3 groups were compared. Results:After 7 d of treatment, the improvement rate of neurological function in early group was significantly higher than that in control group and advanced group ( P<0.05). After 90 d of treatment, modified Rankin scale (mRS) scores in early group were statistically lower than those in control group and advanced group ( P<0.05); good prognosis rate in early group was statistically higher than that in control group and advanced group ( P<0.05). The incidences of intracranial hemorrhage and symptomatic intracranial hemorrhage in early group were significantly lower than those in control group and advanced group ( P<0.05). After 30 and 90 d of treatment, the advanced group had significantly lower mortality than the control group, but significantly higher mortality than the early group ( P<0.05). Conclusion:Edaravone dexborneol immediately after rt-PA intravenous thrombolysis is the optimal timing for super elderly patients with moderate to severe AIS, which can improve the efficacy and safety.

Objective To study the imaging features and the diagnostic value of conventional and enhanced MRI,DWI and magnetic resonance cholangiopancreatography (MRCP)in primary duodenal adenocarcinoma.Methods 12 cases with duodenal adenocarcinoma confirmed by pathological results were analyzed by conventional and enhanced MRI,DWI (3.0T,b＝0 and 800 s/mm2 )and MRCP.Results 11 cases out of twelve cases of duodenal adenocarcinoma demonstrated uneven thickening of intestinal wall,while mass shadow was observed in 1 case.Slight hypointensity of T1 WI and slight hyperintensity of T2 WI were demonstrated in all the twelve cases .DWI demonstrated mild increase in signal in 3 cases,while hyperintensity was observed in 9 cases.On MRCP,ampullary obstructions were observed in 1 1 cases,of which 6 were accompanied with the dilatation of common bile duct (CBD),and 5 with dilatation of CBD and pancreatic duct, while no dilatation of CBD or pancreatic duct was observed in 1 case.The tumors showed moderate enhancement after intravenous administration of contrast material.No normal layered intestinal walls were observed.Conclusion Conventional and enhanced MRI combined with DWI can clearly demonstrate the features of duodenal adenocarcinoma.Additionally,MRCP is instrumental in assessing the lesions involved in the duodenal papilla.

Objective To investigate the difference of the expression of estrogen receptor,progesterone receptor,human epidermal growth factor receptor 2 and Ki-67 protein between primary lesions of breast cancer and its synchronous ipsilateral lymph node metastasis,as well as its clinical implications.Methods Retrospectively analyze invasive breast cancer patients treated in Peking University First Hospital from January 2012 to May 2016.The IHC expressions of estrogen receptor,progesterone receptor,human epidermal growth factor receptor 2 and Ki-67 protein in both the primary and lymph node metastatic lesions are compared and analyzed statistically.The count data were represented as n(％),and comparsion between groups were evaluated using the McNemar test.Results One hundred and fifty-six patients were included,of which on 2 cases (1.3％),estrogen receptor status of primary lesions is different from that of lymph node metastases(P =0.500);on 10 cases (6.4％),progesterone receptor status of primary lesions is different from that of lymph node metastases (P =0.344);on 28 cases (18.0％),Ki-67 protein status of primary lesions is different from that of lymph node metastases (P =0.000 18);on 3 cases (1.9％),human epidermal growth factor receptor 2 status of primary lesions is different from that of lymph node metastases (P =1.000).Conclusion There may be difference between primary lesions and lymph node metastases in the expression of estrogen receptor,progesterone receptor,human epidermal growth factor receptor 2 and Ki-67 protein,which can provide a reference for individualized treatment of breast cancer patients.

Objective To study the clinicopathologic features,diagnosis and differential diagnosis of tumors of haematopoietic and lymphoid tissue in the female productive tract. Methods Eleven cases of myeloid sarcoma and leukemia, 9 of non Hodgkin lymphoma(NHL),13 of cervical lymphoma-like lesions were selected from Peking University People′s Hospital from January 2006 to August 2017. According to WHO classification of tumors of haematopoietic and lymphoid tissues(2008)and updated classification(2016),the cases were studied by microscopy,immunohistochemistry and in situ hybridization.Results In 20 cases of tumors of haematopoietic and lymphoid tissue,the mean and median age was 48.5 and 56 years old(range:16-77 years old).In cases of lymphoma-like lesion of uterine cervix,the mean and median age was 45.9 and 48 years old(range:23-62 years old).The patients with neoplasm present as fever,fatigue, hypogastralgia, colporrhagia and mass etc. Eight cases had history of acute myeloid leukemia, and 3 had myeloid leukemia while pregnancy. One case of chronic lymphocytic leukaemia/small lymphocytic lymphoma(CLL/SLL)had history of ovary small cell carcinoma and high grade serous carcinoma resected with chemotherapy.One case of diffuse large B cell lymphoma(DLBCL)had history of renal transplantation. Lactic dehydrogenase(LDH)was elevated in 9 cases(9/18).The cases of lymphoma-like lesion present as contact bleeding in most cases and all located in cervix. Four cases of neoplasm located in vulva, 1 in vagina,4 in cervix, 4 in uterine corpus, 8 in ovary and 2 in placenta.Clinical staging of NHL: 4 case was stageⅠ,1 case of stageⅢ,and 4 cases of stageⅣ.Pathological morphology:9 cases were myeloid sarcoma, 2 cases were placenta invaded by myeloid leukemia. Six cases were DLBCL, and 1 case was CLL/SLL, 1 case was mucosa associated lymphoid tissuse lymphoma(MALToma), and 1 case was anaplastic large cell lymphoma. Resected mass, chemotherapy was performed in tumors of haematopoietic and lymphoid tissue. Five cases of myeloid sarcoma and 2 of NHL died. In 13 cases of lymphoma-like lesion of uterine cervix, the general condition was good as following up. Conclusions The clinical history, pathological morphology and immunohistochemistry are very important for diagnosing tumors of haematopoietic and lymphoid tissue in the female productive tract.Resection with chemotherapy is recommended in treatment. The prognosis of lymphoma-like lesion of uterine cervix is good,and should be differentiated from lymphoma.

Objective To evaluate the incidental irradiation to the axillary levels Ⅰ,Ⅱ and Ⅲduring the whole breast radiotherapy after breast conserving surgery(BCS)without axillary lymph node dissection(ALND)in breast cancer(BC)patients.Methods A retrospective analysis was performed on the consecutive 42 cases of T1-2N0M0stage BC patients with sentinel lymphnode biopsy(SLNB)and BCS but without ALND.The axillary lymph nodes of Ⅰ,Ⅱ and Ⅲ were delineated according to RTOG atlas guideline.Three radiotherapy plans including conventional tangential field(CTF),three-dimensional conformal radiotherapy(3D-CRT)and forward-planned intensity-modulated radiotherapy(IMRT)for whole breast irradiation were devised for each case.The Prescription dose was 50 Gy per 25 fractions.Doses to axillary levels(Ⅰ-Ⅲ)were evaluated.Results The mean doses delivered to axillary by the three techniques(CTF,3D-CRT and IMRT)were(40.1 ±6.8),(35.4 ±8.3),(32.9 ±7.0)Gy for level Ⅰ(F＝10.269,P＜0.05),(33.2 ±7.1),(30.6 ±6.7),(30.4 ±7.0)Gy for level Ⅱ(P＞0.05)and(9.6 ±6.8),(6.4 ±4.5),(5.2 ±3.7)Gy for level Ⅲ(F ＝8.377,P ＜0.05),respectively.V50(volume receiving 50 Gy)for the three techniques were 21.3％,27.6％,9.6％for level Ⅰ(F＝13.161,P＜0.05),12.9％,15.9％,8.3％for level Ⅱ(F＝2.750,P＜0.05)and 0.4％,0.1％and 0％for level Ⅲ(P＞0.05),respectively.Conclusions The doses coverage to axillary levelsⅠ-Ⅲwere all limited in the three techniques.Therefore,it is necessary to assess the risk of axillary lymph node metastasis adequately to develop individualized radiotherapy plans.

Polycystic ovary syndrome (PCOS) women often deal with the main characteristics of obesity, obesity is caused by the endocrine disorder, the menstrual cycle changes, etc. The main causes of infertility, easy cause anxiety, women have a negative impact on the quality of life through the fueling weight management of patients with PCOS were reviewed, summarized method, explore new train of thought, for fueling beset with PCOS patients provide better health and weight management method.

Objective To study the meaning of breast cancer staging system by AJCC eighth edition to invasive lobular carcinoma and analysis the clinical pathological characteristics.Methods According to the eighth edition of the AJCC staging to evaluate the TNM stage and prognosis evaluation of invasive lobular carcinoma cancer patient in Peking University Shenzhen Hospital from 2011 to 2016,and compared with others in clinical pathological data.Results There were 21 cases of invasive lobular carcinoma,accounting for 2.7％ of all invasive breast cancer.We found that invasive lobular carcinoma shows no significant difference (P ＞ 0.05) in ages,menstrual status,molecular features and anatomic staging and prognosis staging with others;histological grade were significantly different (P ＜ 0.05).There were significant differences in the prognosis and staging of invasive lobular carcinoma.Conclusions Eighth AJCC staging systemn provides a new reference for the clinical treatment of breast cancer,should be evaluated with anatomic stage.Histological grade is relatively good in invasive lobular carcinoma and the prognosis is good,needs more research to the individualized treatment of invasive lobular carcinoma.